What it is
Osteoarthritis in the hand commonly affects the base of the thumb (the carpometacarpal or CMC joint) and the finger joints (DIP and PIP). As a result, the cartilage thins, and the joint forms extra bone (osteophytes). The result is aching, stiffness, and reduced pinch and grip. At the DIP and PIP joints, this process may create firm enlargements known as Heberden’s and Bouchard’s nodes. At the base of the thumb, it limits pinch and fine manipulation.
The goal is dependable hands for daily life: calm pain, preserve range of motion, and rebuild strength. Splints, joint‑protection strategies, and progressive exercise make a significant difference. Procedures are reserved for persistent pain or a mechanical block.
What happens when it occurs
Joint surfaces lose their smooth glide. The capsule stiffens, and small muscles weaken from disuse. People often avoid painful tasks and adopt extended wrist and over-tight grip strategies, which can increase strain. A plan that restores efficient positions and builds capacity improves function even when X‑rays show a change.
Common causes and risk factors
- Age and family history
- Previous fractures or joint injuries
- Repetitive fine work or force tasks through the hands
- Higher body weight and metabolic health factors
Who is most affected
Women are affected more often than men. The dominant hand is commonly involved. CMC arthritis is common in individuals who perform sustained pinching for work or caregiving tasks.
Typical symptoms
- Morning stiffness and a deep ache with use
- Reduced pinch and grip strength
- Catching or grinding and a visible nodal change at DIP or PIP joints
When to seek care
If pain and stiffness limit work, self‑care, or sleep, or if fingers catch or lock.
How we diagnose
History and examination of range, strength, and function. X‑rays show joint space narrowing and osteophytes. Ultrasound or MRI are rarely required unless other conditions are suspected.
Management
- Education on joint protection and task planning at home and work
- Thumb CMC and finger ring splints to support pinch and reduce strain
- Progressive strength for thenar muscles, interossei, and forearm, with grip endurance circuits
- Range and tendon gliding to maintain motion
- Analgesics and image‑guided injections for flares
- Surgery (trapeziectomy for CMC, fusion for painful DIP, selected PIP arthroplasty) when symptoms persist
Rehabilitation milestones
Phase 1 weeks 0–3: pain control, splint trial, gentle range and isometrics.
Phase 2 weeks 3–8: heavy slow resistance for pinch and grip, endurance blocks, joint‑protection skills.
Phase 3 months 2–6: task‑specific strength and dexterity, graded return to hobbies and work.
Post-op timelines depend on the procedure and the surgeon's protocol.
Readiness to progress
- Pain is stable across a week
- Functional pinch and grip improving toward targets
- Daily tasks completed without next‑day flare
Long-term care
- Keep strength and a healthy weight
- Plan workloads during busy weeks
- Use splints strategically for heavy or prolonged tasks
Australia snapshot
- Ubiquitous in primary care and hand clinics across Australia
- Women present more often than men by several fold for thumb base arthritis
- Most people maintain independence with splints and a structured strength programme; procedures are used for persistent cases
Latest insights
Strength and joint‑protection skills change pain more than passive care alone.
Small supports, such as ring or thumb spica splints, make heavy tasks feel lighter.
