Osteoarthritis – Hand

Upper Limb

Overview

Hand osteoarthritis (OA) is a degenerative joint disease characterized by progressive cartilage loss, osteophyte formation, and joint space narrowing, most commonly affecting the distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints, and first carpometacarpal (CMC) joint. This chronic condition predominantly affects individuals over 50 years of age and is more prevalent in women, with symptoms ranging from mild stiffness to significant functional limitation. Early intervention focusing on joint protection, manual therapy, and therapeutic exercise can effectively manage symptoms and slow progression.

Pathophysiology

Hand osteoarthritis develops through progressive degeneration of articular cartilage secondary to mechanical stress, inflammation, and genetic predisposition. The process involves breakdown of the extracellular matrix, reduced proteoglycan content, cartilage fibrillation, and subsequent bone remodeling with osteophyte formation at joint margins. Inflammatory mediators (IL-1, TNF-α) contribute to synovial inflammation and further cartilage degradation. Subchondral bone changes, joint instability, and muscle atrophy around affected joints perpetuate the degenerative cascade. Primary OA occurs without preceding trauma, while secondary OA may follow previous injury, inflammatory arthropathy, or occupational repetitive strain.

Patient Education

Hand osteoarthritis is a progressive but manageable condition; consistent use of joint protection strategies, appropriate activity modification, regular gentle movement, and maintaining hand strength can significantly reduce symptoms and preserve function.

Typical Presentation

Site

Distal interphalangeal (DIP) joints with Heberden's nodes; proximal interphalangeal (PIP) joints with Bouchard's nodes; first carpometacarpal (CMC) joint at thumb base; less commonly affects metacarpophalangeal (MCP) joints

Quality

Aching, throbbing, stiffness, or grinding sensation; may describe 'creaky' or 'grating' feeling during movement

Intensity

Mild to moderate pain, typically 3-7/10; often worse in morning (1-2 hours) and after prolonged activity; may vary with weather changes

Aggravating

Repetitive gripping, pinching, or fine motor tasks (writing, buttoning, opening jars); prolonged immobility; cold weather; forceful hand activities; sustained gripping activities

Relieving

Rest, gentle movement after warm-up, anti-inflammatory medications, heat application, joint protection strategies, reduced activity demands

Associated

Morning stiffness (typically 15-60 minutes), joint swelling and warmth, visible nodal enlargement, reduced grip strength, reduced range of motion, clicking or crepitus, functional limitations with activities of daily living (ADL), occasional joint effusion

Orthopaedic Tests

Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.

Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).

Grade C
A+ABCDModest value: a small but usable shift in probability (LR 2–5 or 0.2–0.5)
modest, supportive value (graded conservatively from a reported range).

Thumb Carpometacarpal (CMC) Grind Test

Procedure

Stabilise the patient's wrist, grip the thumb metacarpal and push it along its long axis into the trapezium while rotating it.

Positive Finding

Pain at the thumb base, with or without crepitus, reproducing the patient's pain.

Sensitivity / Specificity

42–53%/80–93%

Reference: Merritt MM, Roddey TS, Costello C, Olson S. Diagnostic value of clinical grind test for carpometacarpal osteoarthritis of the thumb. J Hand Ther. 2010;23(3):261-7; quiz 268.

Interpretation

Supports thumb base (CMC) osteoarthritis. A negative test does not exclude it, so also check for tenderness over the CMC joint and consider X-rays. The reference previously shown for this test could not be matched to any published paper and has been withdrawn. From 70 thumbs in people with a range of hand disorders, examined by two blinded physiotherapists against radiographs. A positive grind test supports CMC osteoarthritis; a negative test does not rule it out.

Further reading

No accuracy study

Heberden's and Bouchard's Nodes Inspection

Procedure

Look at and feel the backs of the DIP joints (Heberden's nodes) and PIP joints (Bouchard's nodes) for firm bony swellings, comparing both hands.

Positive Finding

Firm, bony enlargement at the back of the DIP and/or PIP joints.

Interpretation

A typical feature of hand osteoarthritis. Soft, warm swelling of the MCP joints or wrists suggests an inflammatory arthritis such as rheumatoid arthritis instead. DIP involvement with nail changes or a swollen whole finger raises the possibility of psoriatic arthritis. The 92% / 98% previously stored here belongs to the 1990 ACR classification criteria for hand osteoarthritis as a whole (Altman 1990), not to node inspection alone. Those criteria are for classifying patients in research, not for diagnosing an individual. No figure is shown for this sign on its own.

Sources

Performance measure

Grip Strength Assessment (Dynamometry)

Procedure

Patient seated, elbow at 90° by the side, forearm in neutral. Measure grip with a hand dynamometer, three trials per hand, and record the mean.

Positive Finding

Weaker grip than on the other hand, or than expected for age and sex.

Reference: Massy-Westropp NM, Gill TK, Taylor AW, Bohannon RW, Hill CL. Hand Grip Strength: age and gender stratified normative data in a population-based study. BMC Res Notes. 2011;4:127.

Interpretation

Grip is often reduced in hand osteoarthritis. Useful for tracking change; it does not help diagnosis.

Sources

Performance measure

Key Pinch (Lateral Pinch) Strength Assessment

Procedure

Measure key pinch (thumb pad against the side of the index finger) with a pinch gauge, three trials per hand, and record the mean.

Positive Finding

Weaker or painful pinch compared with the other hand.

Interpretation

Pinch is especially affected by thumb base osteoarthritis. Useful for tracking change; not a diagnostic test.

Sources

Questionnaire

Duruöz Hand Index (DHI) / Hand Function Assessment

Procedure

The patient completes the 18-item Duruöz Hand Index, rating difficulty with everyday hand tasks (kitchen, dressing, hygiene, office and other tasks) from 0 (no difficulty) to 5 (impossible).

Positive Finding

Higher scores mean greater hand disability.

Reference: Duruöz MT, Poiraudeau S, Fermanian J, Menkes CJ, Amor B, Dougados M, et al. Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap. J Rheumatol. 1996;23(7):1167-72.

Interpretation

A patient-reported measure of hand function, first developed in rheumatoid arthritis and also used in hand osteoarthritis. Useful as a baseline and for tracking change; it does not diagnose.

Sources

No accuracy study

Visual Inspection for Swelling, Erythema, and Deformity

Procedure

Look at both hands at rest and with the fingers spread, noting the pattern of joint swelling, deformity and any redness.

Positive Finding

Bony swelling of the DIP and PIP joints, 'squaring' of the thumb base, and angular deformity of the fingers.

Interpretation

The pattern matters: DIP, PIP and thumb base involvement fits osteoarthritis, whereas soft swelling of the MCP joints and wrists suggests inflammatory arthritis. A single red, hot joint raises the possibility of gout or infection and needs prompt medical review. The reference previously shown for this test could not be matched to any published paper and has been withdrawn. A literature search (Europe PMC, September 2026) found no study reporting the diagnostic accuracy of this test, so no figure is shown.

Sources

⚠ Red Flags

  • •Acute severe swelling with erythema and warmth suggesting septic arthritis or acute inflammatory arthropathy
  • •Systemic symptoms (fever, malaise, weight loss) indicating underlying infection or systemic disease
  • •Rapid progression of joint destruction suggesting inflammatory arthropathy (rheumatoid arthritis) requiring specialist assessment
  • •Neurological symptoms (numbness, tingling) indicating concurrent carpal tunnel syndrome or nerve compression
  • •Signs of vascular compromise (colour changes, coldness, ulceration) suggesting arterial insufficiency

⚡ Yellow Flags

  • •High pain catastrophizing or fear-avoidance beliefs limiting activity beyond structural severity
  • •Depression or anxiety associated with loss of hand function and reduced independence
  • •Social isolation due to difficulty with social activities requiring hand use
  • •Excessive health anxiety or doctor shopping behaviours regarding joint progression
  • •Occupational stress from inability to perform work-related hand activities
  • •Low self-efficacy regarding ability to manage symptoms independently

Osteopathic Techniques

Most hand osteoarthritis trials are in the thumb base (CMC joint). There, manual therapy, alone or with exercise, improved pain on moderate-quality evidence, and orthoses, exercise and nerve mobilisation also helped. The gains over sham are small, so use it alongside exercise and an orthosis rather than on its own.

Region

Thumb CMC, PIP and DIP joints

Technique

Articulation, wrist and hand
Grade B
Moderate evidence: supported by at least one good study
Moderate-quality evidence that thumb-base mobilisation eases pain. The gains over sham are small.

Rationale

Gentle glides of the wrist, carpal and hand joints to restore movement.

How it's done, cautions & evidence

How it's done

Passive, rhythmic, low-velocity glides of the radiocarpal, midcarpal and intercarpal joints, the distal radioulnar joint, the thumb carpometacarpal (CMC) joint and the finger joints, within or up to the end of the available range. In thumb-base osteoarthritis trials this was Maitland-style passive accessory gliding of the CMC joint.

Cautions

After a fall on the hand, rule out a fracture first: scaphoid fractures are often missed on the first X-ray, so snuffbox pain needs a splint and repeat imaging. Do not move a joint that is splinted for a tendon injury: the DIP in mallet finger, the PIP in a central slip (boutonnière) injury.

Evidence in Osteoarthritis – Hand

Bertozzi 2015 (SR/MA, 16 RCTs): moderate quality evidence that manual therapy, and exercise combined with manual therapy, improve pain in thumb CMC osteoarthritis at short and intermediate term. Gutiérrez Espinoza 2022 (SR/MA, 5 trials): manual therapy beat sham for grip strength and pressure pain threshold, but the differences were not clinically important. Evidence is for the thumb base, not the finger joints.

Region

Forearm flexors and extensors

Technique

Soft tissue, elbow and forearmNo trials found

Rationale

Soft tissue to the forearm flexor and extensor muscles that move the wrist and fingers.

How it's done, cautions & evidence

How it's done

Hands-on kneading, stroking and sustained pressure to the forearm extensor and flexor muscles, their tendon origins at the epicondyles, the supinator, the pronators and the triceps. Deep transverse friction across the tendon origin is part of the Cyriax method for lateral elbow pain.

Cautions

Avoid direct pressure on an olecranon bursitis. A red, warm, tender bursa, especially with fever, may be septic and needs medical review.

Evidence in Osteoarthritis – Hand

Searched 26 Oct 2026: no trials of forearm soft tissue in hand osteoarthritis.

Region

Hand intrinsic and thenar muscles

Technique

Soft tissue, wrist and handNo trials found

Rationale

Soft tissue to the wrist and hand: flexor retinaculum, palmar fascia, thenar and intrinsic muscles.

How it's done, cautions & evidence

How it's done

Hands-on kneading, stroking and sustained pressure to the soft tissues of the wrist and hand: the flexor retinaculum and thenar muscles over the carpal tunnel, the first dorsal compartment, the wrist ligaments, the palmar fascia, the hand intrinsics and the finger flexor sheath at the A1 pulley. In carpal tunnel trials, soft tissue mobilisation was often combined with neural mobilisation.

Cautions

In Guyon canal syndrome, avoid prolonged pressure over the hypothenar eminence. After a fall on the hand, rule out a fracture first: scaphoid fractures are often missed on the first X-ray.

Evidence in Osteoarthritis – Hand

Searched 26 Oct 2026: no trials of hand soft tissue in hand osteoarthritis.

Region

Radial and median nerves (neck to hand)

Technique

Neural mobilisation, upper limb
Grade C
Limited evidence: indirect or low-quality support only
Radial nerve mobilisation beat sham in thumb-base osteoarthritis. The trials were small and at high or unclear risk of bias.

Rationale

Gentle sliding of the nerve along its path through the neck, arm, forearm and hand.

How it's done & evidence

How it's done

A movement-based treatment aimed at the nerve and the tissues around it. Gentle, rhythmic neck and arm movements either slide the nerve along its path (sliders) or lightly tension it (tensioners), with a median, radial or ulnar bias. One review found sliders helped more in acute pain and tensioners in chronic pain.

Evidence in Osteoarthritis – Hand

Hamasaki 2020 (SR, 34 RCTs, mostly unclear or high risk of bias): low-to-moderate quality evidence that radial nerve mobilisation, and hand exercise plus CMC joint and median/radial nerve mobilisation, beat sham ultrasound for pain and/or function in thumb-base osteoarthritis.

Rehabilitation Exercises

Finger Extension with Resistance Band

Range of MotionBeginner

Gentle Finger Flexor Stretch

StretchingBeginner

Grip Strengthening with Soft Ball

StrengtheningBeginner

Thumb Opposition Exercises

Range of MotionBeginner

Wrist and Hand Extensor Stretch

StretchingBeginner

Intrinsic Hand Muscle Strengthening (Lumbricals)

StrengtheningIntermediate

Finger Flexion and Extension Sequence

Range of MotionIntermediate

Hand Posture Awareness and Positioning

PosturalBeginner

Isometric Hand Muscle Activation

StrengtheningIntermediate

Wrist Flexion and Extension Mobility

Range of MotionIntermediate

Progressive Pinch Grip Training

StrengtheningIntermediate

Cervical and Shoulder Postural Correction

PosturalBeginner

Referral Criteria

  • •Rapid progression of joint destruction or deformity suggesting inflammatory arthropathy; recommend rheumatology referral
  • •Severe pain unresponsive to conservative management and impacting function; consider orthopedic consultation for surgical options (joint replacement, fusion, or osteotomy)
  • •Suspected concurrent inflammatory conditions (rheumatoid arthritis, psoriatic arthritis); recommend blood tests and specialist assessment
  • •Neurological symptoms (numbness, tingling in fingers) indicating carpal tunnel syndrome or nerve compression; may require nerve conduction studies
  • •Signs of septic arthritis (acute inflammation, fever, systemic symptoms); require immediate medical assessment
  • •Functional loss limiting ADL and independence despite 8-12 weeks conservative management; occupational therapy assessment for adaptive strategies and assistive devices
  • •Concern for secondary OA related to previous trauma or underlying systemic condition; may warrant imaging (X-ray, ultrasound, MRI) and specialist evaluation