I don't need to tell you how important normal hand function is to nearly everything we do. The bones, joints, muscles, ligaments, tendons, nerves and blood vessels work intricately and harmoniously to bring together the alignment, coordination, and strength that allow us to perform fine motor tasks.
A Bit of Hand Anatomy
There are 27 bones in the wrist and hand. The 8 small bones in the wrist are called carpals. In the palm of the hand, several of the carpals connect to 5 metacarpals. Each metacarpal connects to one of the fingers or the thumb. The phalanges are bones that align to form each finger and thumb (i.e., the finger bones). Knuckle joints form where the phalanges connect to the metacarpals and are referred to as the metacarpophalangeal joints or MCP joints. The MCP joints work as hinge joints to bend and straighten the fingers and thumb.
Each finger has three phalanges that are separated by two joints, known as interphalangeal joints (IP joints). The IP joint that sits closest to your MCP joint (knuckle) is known as the proximal interphalangeal joint (PIP joint). The IP joint that is located closest to the end of your finger is known as the distal interphalangeal joint (DIP joint). Your thumb has one IP joint between its two phalanges. IP joints also function as hinge joints to bend and straighten your fingers and thumb.
The joints of your hand, fingers, and thumb are covered with articular cartilage which absorbs shock and allows for friction-free movement. Articular cartilage covers the ends of bones that come together to form many joint. When cartilage loss develops in the joints of the hand, you may experience significant pain. Initially, the symptom of hand pain is vague. You may first suspect an injury, but hand pain can be caused by disease, too, such as arthritis.
Symptoms of Hand Arthritis
Typically, the first sign of hand arthritis involves pain that develops after extensive use of the hand. Increased use of the hand can cause increased pain, while rest can relieve it, especially in the early stages. As hand arthritis advances, even simple activities, such as opening a jar or door knob, can cause hand pain. Morning stiffness may become more pronounced.
Other symptoms associated with hand arthritis may include: swelling, warmth due to inflammation, crepitus, fingers that snap or lock, and the appearance of cysts or nodules on the fingers.
Signs and symptoms of hand arthritis associated with rheumatoid arthritis commonly include firm nodules along the fingers, a soft lump on the back of the hand, drifting of the fingers away from the thumb (ulnar deviation), tendon rupture which causes a sudden inability to bend or straighten the fingers, and joint deformity. Sometimes, there is numbness or tingling of the hand (i.e., carpal tunnel syndrome).
Symptoms of hand arthritis caused by osteoarthritis often involve bony nodules that develop at the PIP joint (i.e., Bouchard's nodes) or the DIP joint of the finger (i.e., Heberden's nodes). Another classic sign of hand osteoarthritis is pain at the base of the thumb.
Other signs include redness and telangiectasia (dilation) of nail fold capillaries which is often linked to connective tissue diseases, such as lupus. Sclerodactyly, or tightening of the skin over the fingers, and digital ulcers are often signs of scleroderma. Dactylitis, or swelling of an entire digit, is associated with one of the spondyloarthropathies, such as psoriatic arthritis.
Physical Examination of the Hand Helps With Diagnosis
The physical examination performed by your doctor will yield information pertinent to formulating a diagnosis. With your hands open, your doctor can check the alignment of your fingers, as well as look for any visible abnormalities. Your doctor also can test the function and strength of your hand by having you pinch or grip objects. Your hand should also be felt by the doctor to determine if there is joint tenderness.
X-rays will also be taken so that information can be gathered about such things as joint space narrowing, the development of osteophytes, and the appearance of bone along the joint margins. If rheumatoid arthritis is suspected, blood tests (such as rheumatoid factor, sedimentation rate, CRP, and anti-CCP) may be ordered to help confirm the diagnosis.
Treatment for Hand Arthritis
The goal of treatment for hand arthritis is to relieve pain and improve function. Treatment may include the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or analgesic (pain) medications. Rest, heat, cortisone injections, and splints may also be used.
It is essential to preserve function of the hand. Exercises help to maintain movement and function. A few sessions with a hand therapist will allow you to learn about the exercises which would be optimal for your individual situation.
Surgery, is considered only as a last resort, when all other treatment options have failed. Hand surgery is not generally performed for purely cosmetic reasons. The main purposes of hand surgery are pain relief and to preserve or restore function.
A Patient's Guide to Hand Anatomy. e-Orthopod. Accessed 01/14/13.
Primer on the Rheumatic Diseases. Examination of Specific Joint Areas - Hand and Wrist. Klippel John, M.D. et al. Thirteenth Edition. Arthritis Foundation.
Hand Arthritis: Rheumatoid Arthritis. American Society for Surgery of the Hand. 2008.
Hand Arthritis: Osteoarthritis. American Society for Surgery of the Hand. 2008.