Hand or Wrist Joint Pain

Pain that occurs in or around the joints of the hand or wrist can range from constant aching to intermittent sharp pain. These pains can occur with activity or at rest. The specific joints of the hand are the distal interphalangeal (DIP), proximal interphalangeal (PIP), metacarpophalangeal (MCP), the carpometacarpal (CMC) (Figure 1) and the radiocarpal joint (wrist) joints (Figure 2).
Figure 1
The finger joints
Figure 2
The wrist joints

Causes

There are many reasons for hand joint pain. Below are some examples of the most common reasons, but this is not an all-inclusive list.
  • Arthritis
    • Osteoarthritis: Sixty percent of adults older than 60 years of age have arthritis in the DIP joints of the hand. The thumb (CMC) joint or “basal” joint of the thumb is painful in up to 15% of people older than 30. In women after menopause, the numbers increase to 33%. After 75 years, up to 25% of men and 40% of women will have symptomatic CMC joint arthritis.
    • Rheumatoid arthritis: This is an inflammatory arthritis that affects not only the small joints of the hands, but large joints and the spine.The cells that line the joint are synovial cells. These cells become inflamed, leading to erosion of bone in joints.This condition can run in families.
    • Psoriatic arthritis: Up to 25% of adults with psoriasis will develop psoriatic arthritis.
  • Automimmune diseases
    • Lupus: Up to 75% of patients will have joint involvement. Of those 90% will have symptoms in the hands and wrists.
    • Scleroderma: This can cause calcifications in the skin and around joints, joint contractures, and skin changes.
  • Fibromyalgia
  • Gout/Pseudogout
    • Gout is caused by high levels of uric acid within the blood. This can cause deposits of uric acid crystals around or in the joints of the hand.After arthritis, high uric acid levels are a common cause of hand pain in elderly women.
    • Pseudogout, orcalcium pyrophosphate disease (CPPD), is caused by calcium pyrophosphate crystals.
  • Tendinitis
  • Infection: Lyme disease in endemic areas
  • Joint imbalance or hypermobility disorders such as Ehlers-Danlos
  • Trigger Finger
  • Vitamin D or B12 deficiency

Signs and Symptoms

You may have some of these symptoms with joint pain:
  • Aching pain and stiffness that is greatest in the morning and improves with activity
  • Swelling of the affected joint
  • Limitation in motion, such as difficultly making a tight fist
  • Decreased grip or thumb pinch strength
  • With gout or infection, increased pain, swelling, redness and warmth to the affected joint

Diagnosis

When you visit your doctor and report hand joint pain, your physician will ask you questions about your family history, personal medical history, what hand you write with, medications, when the pain started, what makes it feel better or worse, and any injury or trauma to your hands. Knowing that information as well as reporting your type of work, hobbies, and what makes the pain better or worse is helpful to identify the source of the hand joint pain.

Treatment

X-rays of your hands will look for evidence of arthritis or trauma. Fractures, mal alignment, narrowing of the joint space, bone spurs, cysts, or erosive changes can be seen in the bone. You can rule out any injuries (broken bones) and somewhat see soft tissue swelling (although MRI is a better test to look at the soft (non-bone) parts of our body such as ligaments and tendons).

Based on your history, physical examination and x-ray findings, your physician may order blood tests. Blood tests will look for signs of infection, inflammation, or antibodies that can be seen in diseases such as rheumatoid arthritis or lupus.

The first line treatments for joint pain include conservative treatment such as:
  • Medications, including oral or topical anti-inflammatories
  • Over the counter ointments/oils to relieve pain
  • Heat and/or ice
  • Activity changes, such as using adaptive equipment like electric can openers, mounted jar and bottle openers, and larger pens, tools, or grips for racket/club sports. This can help decrease the stress across the joints and decrease pain.
  • Topical cannabidiol (CBD) oils/creams to improve overall pain and function, which is a newer treatment for thumb basal joint arthritis.
  • Hand therapy, which helps to improve joint mobility and strength
  • Braces, which help to prevent or improve contractures
When conservative treatments fail, your physician may offer corticosteroid injections. Steroid injections (also known as cortisone shots) lower pain and stiffness by supplying anti-inflammatory (steroid) medication directly into the painful joint or tendon. It can be painful to have an injection into a small joint and there are recommended limits to the number of injections into a joint to no more than 3 to 4 a year.

Surgery is saved for when all other options fail. Surgical options include:
  • Arthroplasty (joint replacement), which can involve silicone (PIP joints) and/or pyrocarbon (MCP joints) implants
  • Carpal bone excision (trapeziectomy) and supensionplasty for thumb CMC joint arthritis
  • Fusion/arthrodesis (eliminating the joint so the finger does not bend there) of the involved joint, which is most dependable for DIP joints of the fingers and IP joint of the thumb
  • Surgery for wrist arthritis that can include removal of the arthritic bones with or without partial wrist fusion. In some cases, total wrist fusion is done.
For inflammatory type of conditions, care is provided by a team of physicians to limit episodic “flares” of the disease. These teams might include a rheumatologist, primary care physician, immunologist, neurologist, and geneticist, as well as the hand surgeon. Patients with gout may need long-acting medications, such as allopurinol, to help prevent uric acid accumulation. Patients with rheumatoid arthritis, psoriatic arthritis, or lupus may benefit from disease-modifying antirheumatic drugs (DMARDs) with the goal to limit inflammation with the aim of remission of the disease to decrease risk of long-term pain and loss of hand function.

Discuss your treatment plan with your hand surgeon.




© 2023 American Society for Surgery of the Hand

This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand.Find a hand surgeon near you.



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