Early Signs and Symptoms of Arthritis in Knuckles

Reviewed on 12/17/2020
The most common knuckle arthritis is rheumatoid arthritis.
The most common knuckle arthritis is rheumatoid arthritis.

Pain, swelling, and tenderness are usually considered as early signs and symptoms of knuckle arthritis. Tiny bumps pop out on the top knuckles of some of the fingers, and fingers become stiff. Other possible signs and symptoms may include:

  • Patients usually complain of deep, aching joint pain that is worsened by the grip and pinch activities
  • Stiffness in the fingers especially in the mornings
  • Swelling, especially in the spaces between the large knuckles, is often present
  • Limited range of motion or loss of motion in fingers
  • Stretched or shiny skin
  • Skin pitting: Skin that dimples or pits after pressing on the affected area for a few seconds
  • Warmth or redness of the affected area
  • Visible deformity

What is knuckle arthritis?

Knuckle arthritis is less common than arthritis affecting the other smaller joints in the hand or the joint where the thumb joins the wrist (CMC). The most common knuckle arthritis is rheumatoid arthritis. In this situation, the joint lining (synovium) produces chemical factors that inflame and destroy the cartilage and soft tissue, such as ligaments and tendons. The result is that the joint surfaces are destroyed and the other fingers drift towards the little finger. The causes may include:

  • Age: The older we get, the more likely we are to develop arthritis. Over time, our cartilage that cushions and lubricates your joints wear down, eventually leading to arthritis.
  • Genetics: Some people are genetically predisposed to developing thumb arthritis. The estimated onset time of thumb arthritis can usually be determined by family medical history.
  • Gender: Women are more disposed to knuckle arthritis.
  • Previous injury to the wrist or the area surrounding knuckles and finger

If the pain starts to interfere with daily activities of daily living, then a visit with a hand surgeon could be helpful. The diagnosis is usually confirmed using plain x-rays. Special x-rays are also helpful to look carefully at the metacarpal head, particularly in milder cases.

QUESTION

The term arthritis refers to stiffness in the joints. See Answer

What are the treatment options for knuckle arthritis?

Treatment usually begins when the joint first becomes painful. This may only occur with heavy use of hands and fingers. Treatment options for knuckle arthritis include:

Nonsurgical treatment

  • Ice and hot therapy: Applying ice or and hot compress to sore knuckles can help reduce swelling and pain.
  • Medication: Prescribed or over the counter pain reliever, such as ibuprofen (Advil, Motrin) can help ease the pain.
  • Vitamin C: Vitamin C may reduce pain in joints as per recent research.
  • Reducing the activity or changing from occupations that require heavy repetitive hand and finger motions may be necessary to help control the symptoms.
  • An injection of cortisone into the finger joint can give temporary relief. Cortisone is a very powerful anti-inflammatory medication. When injected into the joint itself, it can help relieve the pain. Pain relief is temporary and usually lasts several weeks to months.
  • Rehabilitation services, such as physical and occupational therapy, play a critical role in the nonoperative treatment of finger joint arthritis. A primary goal is to help the patient learn how to control symptoms and maximize the health of the hand and fingers. The patient may learn ways to calm pain and symptoms, which might include the use of rest, heat, or topical rubs. Range of motion and stretching exercises are prescribed to improve finger movement. Strengthening exercises for the arm and hand help steady the hand and protect the finger joints from shock and stress. The therapist will also let you know some tips on how to get tasks done with less strain on the joint.
  • A custom finger brace or splint may be prescribed to support the finger joints. These devices are designed to help reduce pain, prevent deformity, or keep a finger deformity from getting worse.

Surgical treatment

  • Fusion: A fusion (or arthrodesis) of any joint is designed to eliminate pain by allowing the bones that make up the joint to grow together or fuse into one solid bone. Fusions are used in many joints and were very common. Joint fusions are still very commonly used for many different joints to treat the pain and potential deformity of arthritis.
  • Artificial joint replacement: Artificial joints are available for the finger joints. These plastic or metal prostheses are used by some hand surgeons to replace the arthritic joint. The prosthesis forms a new hinge, giving the joint freedom of motion and pain relief. The procedure for putting in a new joint is called arthroplasty.
  • Recovery: The hand may be bandaged with a well-padded dressing and a finger splint for support after surgery. Physical or occupational therapy sessions may be needed after surgery for up to 8 weeks. The first few treatments are used to help control the pain and swelling after surgery. Some of the exercises are recommended to help strengthen and stabilize the muscles around the finger joint. Other exercises are used to improve fine motor control and dexterity of the hand. The patient usually takes less than 6 months to get completely recovered.

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References
Fox RI, Stetka BS, Fox CM, et al. Notable Knuckles: Evaluating Arthritic Conditions of the Hand. Medscape. https://www.medscape.com/slideshow/knuckles-6004218

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