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Osteoarthritis of the hand

Hand osteoarthritis is an abnormality of the cartilage which lines bones in the joints in the fingers and wrist. There normally is a very smooth covering of cartilage over the bones that allows normal, smooth and painless motion.

In the case of osteoarthritis, the smooth cartilage lining the ends of the bones becomes damaged, rough or thin. Usually the smallest knuckles and middle knuckles are involved, and the large knuckles (where the fingers attach to the hand) are fine. The base of the thumb near the wrist is also a favorite site for osteoarthritis.

Aching pain and stiffness is very common in osteoarthritis. The knuckles may be enlarged and appear to be developing a knobby appearance. Usually there is not a large amount of redness in a joint with osteoarthritis. If it is not too bad, the stiffness often will improve after some ‘loosening up’ of the fingers with use. If the thumb basal joint has osteoarthritis, lifting pans, turning doorknobs, gripping gardening tools or tennis rackets may be painful. There may be some extra stiffness in the morning or after a period of rest, but if the stiffness lasts more than one or two hours it may not be osteoarthritis, but a form of inflammatory arthritis (such as psoriatic arthritis, rheumatoid arthritis or gout).

Osteoarthritis is sometimes called ‘wear and tear’ arthritis. It may be caused by previous overuse or abnormal use, or due to an injury in the past which damaged the cartilage. Over months or years the damage to the cartilage worsens, and symptoms start. Sometimes osteoarthritis in the fingers seems to run in families.

Usually the appearance of the fingers, and the joints involved are enough to make the diagnosis of osteoarthritis. Routine x-rays show narrowing between the bones where the cartilage has worn. Extra bone may buildup around the joint, causing the knobby enlargement. Sometimes osteoarthritis may be present with other forms of arthritis such as gout or rheumatoid arthritis.

The treatment of hand osteoarthritis depends upon the severity of the pain. If osteoarthritis limits the use of the hand, early treatment often consists of physical or occupational therapy, thumb stabilizer splints, and exercises to reduce the stiffness and pain in the joint, and improve function. For more severe pain, oral or rub-on (topical) medications may be recommended. These may include over the counter medications such as Tylenol (generic = acetaminophen) Aleve (generic = naproxen), Motrin (generic = ibuprofen) or aspirin. Various prescription medications which belong to a group of medications called ‘non-steroidal anti-inflammatory medications (or ‘NSAIDs’ for short) are commonly recommended. Some of the more commonly prescribed of these include medications such as Celebrex, Motrin, Naprosyn, or Voltaren gel. (A complete list is available at the reference below.) More recently, a medication of a different class called Cymbalta has been approved to treat the pain from osteoarthritis.

For severe pain in the thumb basal joint injections of cortisone-like medication may provide temporary relief. If thumb osteoarthritis is severe, surgery on the joint may be very effective.

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