Dr Pr. D’Agostino, MD, PhD

Hand Clinic Brussels - Lasne

LOUISE +32 2 534 29 99 LASNE +32 2 653 11 11

Osteoarthritis of the fingers

QT Pathologies (EN)

Arthritis literally means "inflamed joint". Normally a joint consists of two smooth, cartilage-covered bone surfaces that fit together as a matched set and that move smoothly against one other. Arthritis results when these smooth surfaces become irregular and don't fit together well anymore and essentially "wear out."

Arthritis can affect any joint in the body, but it is most noticeable when it affects the hands and fingers. Each hand has 19 bones, plus 8 small bones and the two forearm bones that form the wrist. Arthritis of the hand can be both painful and disabling.

In the hand, osteoarthritis most often develops in three sites :

  • at the base of the thumb (rhizarthrosis)
  • at the end joint closest to the finger tip (the distal interphalangeal or DIP joint)
  • at the middle joint of a finger (the proximal interphalangeal or PIP joint)

It also often develops in the wrist (see osteoarthritis of the wrist section).

  • Polydigital osteoarthritis : clinical aspect Polydigital osteoarthritis : clinical aspect
  • Polydigital osteoarthritis : clinical aspect Polydigital osteoarthritis : clinical aspect

The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Other causes of arthritis of the hand are infection, gout, and psoriasis.

Stiffness, swelling, and pain are symptoms common to all forms of arthritis in the hand.

With osteoarthritis, bony nodules may develop at the middle, or PIP, joint of the finger (Bouchard's nodes), and at the end-joints, or DIP, of the finger (Heberden's nodes).

A deep, aching pain at the base of the thumb is typical of osteoarthritis of the basilar joint. Swelling and a bump at the base of the thumb where it joins the wrist may also be observed. Grip and pinch strength may be diminished, causing difficulty with activities such as opening jars or turning keys.

Pain, swelling, stiffness, and diminished strength are also seen with osteoarthritis of the wrist.

  • Heberden’s node (black arrow) and Bouchard’s node (white arrow) Heberden’s node (black arrow) and Bouchard’s node (white arrow)

The clinical appearance of the hands and fingers helps to diagnose the type of arthritis.

X-rays will also show certain characteristics of osteoarthritis, such as narrowing of the joint space, the formation of bony outgrowths (osteophytes or "nodes"), and the development of dense, hard areas of bone along the joint margins.

  • Polydigital osteoarthritis : radiological aspect Polydigital osteoarthritis : radiological aspect
  • DIP osteoarthritis : radiological aspect DIP osteoarthritis : radiological aspect

Treatment is designed to relieve pain and restore function :

  1. Anti-inflammatory or other analgesic medication.
  2. Brief periods of rest may help (if the arthritis has flared up).
  3. Finger or wrist splints at night and for selected activities.
  4. A cortisone injection can often provide relief of symptoms, but does not cure the arthritis. Surgery is usually not advised unless these more conservative treatments fail.
  5. Surgery is indicated when the patient either has too much pain or too little function. The goal is to restore as much function as possible and to eliminate the pain or reduce it to a tolerable level. type of surgery is used depends on the particular joint(s) involved, your activities, and your own needs :
  • Joint fusion : arthritic surface is removed and the bones on each side of the joint are fused together, eliminating motion from the problem joint. Joint fusion may be used to relieve pain and correct deformities that interfere with functioning.
  • Joint reconstruction : degenerated joint surface is removed in order to eliminate the rough, irregular bone-to-bone contact that causes pain and restricts motion. Once the degenerated portion of the joint surface is removed, it may be replaced with rolled-up soft tissue, such as a tendon, or with a joint replacement implant.

During your consultation, Dr. D'Agostino will discuss the current treatment options and can help you choose the best treatment based on your particular case.

  • Fusion of the IP joint of the thumb Fusion of the IP joint of the thumb
  • Fusion of the DIP joint of the index  Fusion of the DIP joint of the index
  • Fusion of the MCP joint of the thumb Fusion of the MCP joint of the thumb