Osteoarthritis (OA) is the most common degenerative joint disease affecting the hand. It is characterized by progressive loss of articular cartilage, subchondral bone remodeling, and osteophyte formation, leading to pain, stiffness, and functional limitations. OA typically affects the base of the thumb (CMC joint), distal interphalangeal (DIP) joints, and proximal interphalangeal (PIP) joints. Understanding its pathophysiology and clinical manifestations is essential for optimizing treatment strategies, both conservative and surgical.
The pathophysiology of hand OA is multifactorial and begins with mechanical wear and tear on articular cartilage. Key mechanisms include:
Chondrocyte injury due to repetitive stress.
Inflammatory mediators (IL-1β, TNF-α) accelerating cartilage degradation.
Subchondral bone sclerosis and osteophyte formation.
Joint space narrowing and misalignment, leading to instability and deformity.
These changes result in pain, limited range of motion, and impaired grip strength.
Symmetrical Joint Involvement – Both hands may be affected.
Thumb Base Pain – Common in CMC joint OA (“rhizarthrosis”).
Nodularity – Heberden’s (DIP) and Bouchard’s (PIP) nodes.
Joint Stiffness – Worse after inactivity or in the morning.
Reduced Range of Motion – Affects both active and passive movement.
Crepitus – Grating sensation on joint movement.
Pain Exacerbated by Activity – Worsens with repetitive use.
Deformity – Malalignment, including ulnar drift at MCP joints.
Joint Instability – Osteophytes disrupt joint mechanics.
Swelling – Mild joint effusion despite OA being noninflammatory.
Loss of Grip Strength – Functional impairment is common.
Tenderness on Palpation – Discomfort over affected joints.
Bony Enlargement – Visible changes in DIP and PIP joints.
Radiographic Changes – Joint space narrowing, osteophytes.
Slow Progression – Worsens over years.
Age-Related Prevalence – More common after 50 years of age.
Gender Predilection – Higher prevalence in women.
Genetic Component – Family history increases risk.
Daily Function Impact – Fine motor skills affected.
Early Response to Conservative Treatment – Delays progression.
Conservative Management
For mild-to-moderate OA, first-line treatment includes:
Activity Modification & Ergonomics – Reduce joint stress using adaptive devices.
Splinting & Bracing – Thumb braces can help stabilize CMC joints.
Pharmacologic Therapy:
NSAIDs for pain relief.
Topical agents (e.g., capsaicin cream) to reduce systemic effects.
Hand Therapy – Exercises to maintain mobility and strength.
Intra-Articular Injections – Corticosteroids provide temporary relief; hyaluronic acid has variable efficacy.
Surgical Options
For advanced OA with significant functional impairment, surgery is considered:
Osteotomy & Osteoplasty – Bone reshaping to improve alignment.
Arthroplasty:
CMC Joint Replacement for severe thumb OA.
Interphalangeal Joint Arthroplasty for advanced DIP/PIP involvement.
Arthrodesis – Fusion for stability in severe deformity cases.
Synovectomy – Less common but can relieve pain in some cases.
Hand OA is a progressive disorder with significant implications for daily function. Its pathophysiology involves cartilage loss, subchondral bone changes, and osteophyte formation driven by mechanical stress and biochemical mediators. Clinically, it presents with hallmark signs like joint crepitus, nodularity, and reduced grip strength. Current management strategies emphasize conservative treatment, with surgery reserved for severe cases. A multidisciplinary approach is key to optimizing long-term outcomes.
Gelberman, R. H., et al. “Surgical Management of Thumb CMC Osteoarthritis.” J Hand Surg (Am Vol), 2020.
Bishop, A. T., et al. “Nonoperative Strategies in Hand Osteoarthritis: A Review.” Hand Clinics, 2019.
Manske, P. R. “Advances in Joint Reconstruction for OA of the Hand.” J Hand Surg (Eur Vol), 2018.
Norris, C., et al. “Recent Trends in Arthroplasty for Hand Osteoarthritis.” Hand Surgery, 2021.
Baldwin, S. A., et al. “Multidisciplinary Approaches to Managing Hand OA.” Hand Clinics, 2021.