Hand and Thumb Osteoarthritis
Arthritis in the finger joints and the base of the thumb: knobbly knuckles, stiffness and a weak, sore grip. Very common from middle age. Hand exercises, a thumb splint and anti-inflammatory gel do most of the work.
Symptoms. Aching and stiffness in the end and middle finger joints, firm bony lumps beside them, and pain at the base of the thumb when pinching, opening jars or turning keys. Joints can flare up red and swollen for a while, then settle.
Who gets it. More likely with age, in women, when it runs in the family, and after a hand injury.
How it’s diagnosed. From the look and feel of your hands; X-rays are rarely needed. Blood tests are used if the pattern suggests another type of arthritis, such as swollen knuckles at the base of the fingers or morning stiffness lasting more than an hour.
The hand osteoarthritis ladder
Start at the bottom. Steps 1 to 3 suit almost everyone; the rest are for stubborn pain, inflamed flares or a badly damaged thumb base.
- Step 1 · Self-careHand exercisesDaily range-of-motion and grip-strengthening exercises, a few minutes at a time.
- Works
- Small improvements in pain, function, stiffness and grip strength in trials
- Cost
- Free
- How long
- 6–12 weeks to judge; keep going
- Watch for
- A little extra ache is OK. Back off if a joint flares hot and swollen.
Your hands do thousands of jobs a day. Give them 10 minutes of training.
- Step 2 · Self-careThumb-base splintA soft or firm splint that supports the base of the thumb, worn during tasks or at night.
- Works
- Little difference in the first few weeks, but worn for several months it eases pain and improves function. Short and long splints work about equally
- Cost
- About $30–80 off the shelf; more if custom-made by a hand therapist
- How long
- Give it at least 3 months
- Watch for
- Skin rubbing, or stiffness if worn all the time.
Patience required. The payoff comes in months, not days.
- Step 3 · PharmacyAnti-inflammatory gel (diclofenac or ibuprofen)Rubbed on the sore joints up to 3 or 4 times a day.
- Works
- About as much relief as anti-inflammatory tablets, with fewer side effects
- Cost
- About $15–30 a tube
- How long
- 2 weeks to judge; use as needed
- Watch for
- Skin redness or itch. Wash hands before touching eyes.
Hands are close to the surface, so the gel actually gets there.
- Step 4 · PharmacyAnti-inflammatory tablets, short termIbuprofen or naproxen, or celecoxib on prescription, at the lowest dose for the shortest time.
- Works
- The strongest medicine effect for hand arthritis, but still moderate, with more side effects than gel
- Cost
- Pharmacy about $5–15; celecoxib under the $25 PBS co-payment
- How long
- Days to a couple of weeks
- Watch for
- Stomach bleeds, kidney and heart risks. Not safe for many people: check with your GP or pharmacist.
A flare tool, not a lifestyle.
- Step 5 · Allied healthHand therapist (occupational therapist or physio)Fitting splints, a tailored exercise plan, and easier ways and gadgets for everyday tasks.
- Works
- No precise trial figures for referral itself; it’s how most people get a good splint and exercise plan
- Cost
- About $90–130 a session; Medicare rebates for up to 5 allied health visits a year with a GP care plan
- How long
- A few sessions, then keep going at home
- Watch for
- Ask for gadgets you’ll actually use: jar openers, thicker pens, key turners.
Tools are not cheating. They’re engineering.
- Step 6 · PrescriptionShort course of prednisolone for an inflamed flareLow-dose steroid tablets, sometimes used when several joints are red and swollen.
- Works
- In a trial of 92 people with inflamed hand arthritis, 6 weeks of 10 mg a day eased finger pain about 16 points out of 100 more than a dummy tablet. The benefit faded once it was stopped
- Cost
- Under the $25 PBS co-payment
- How long
- Weeks, then tapered off
- Watch for
- Raised blood sugar, mood and sleep changes. Not a long-term treatment.
A short reset for a flare, not a permanent fix.
- Step 7 · ProcedureSteroid injectionAn injection into a single very sore joint.
- Works
- Helped finger joints in one good trial, but no better than a dummy injection at the base of the thumb
- Cost
- From bulk-billed to a few hundred dollars, depending on the clinic and whether ultrasound is used
- How long
- Weeks
- Watch for
- Skin thinning or colour change at the site; rare infection.
Useful for the odd fiery finger. Disappointing for the thumb base.
- Step 8 · SpecialistThumb-base surgeryFor severe thumb-base pain despite good non-surgical care, often removing one small wrist bone (trapeziectomy).
- Works
- No single operation is clearly best, and the more complex ones have more complications. There are no trials against non-surgical care
- Cost
- Free in the public system (expect a wait); private costs vary
- How long
- Several months to recover full grip
- Watch for
- Weeks in a splint or cast, then hand therapy.
The last rung, and a big commitment for a small joint.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- HydroxychloroquineA 12-month trial in 248 people found it no better than a dummy tablet for pain, and it didn’t slow joint damage.
- Biologic injections (anti-TNF medicines)No better than a dummy treatment for pain, function or grip in hand arthritis trials.
- GlucosamineNICE advises against it for osteoarthritis. No good evidence it helps hands.
- Hyaluronic acid (“gel”) injectionsNICE advises against them for osteoarthritis.
- Night splints for the end finger jointsOne trial found no benefit. The thumb-base splint is the one with evidence.
What you can do
- Warm water or a heat pack before exercises can ease morning stiffness.
- Spread the load: use both hands, bigger joints, and lever-style taps and handles.
- Thicker grips on pens, cutlery and tools are easier on sore joints.
- Keep using your hands. Gentle use is good for them.
See your GP if
- Pain stops you working, sleeping or doing what you enjoy
- Knuckles at the base of the fingers or wrists are swollen, or morning stiffness lasts more than an hour
- You also have psoriasis, or joints elsewhere are swelling
- Thumb pain is making everyday tasks hard despite a splint and exercises
See a doctor the same day for a hot, red, swollen finger or hand with fever, red streaks spreading up the arm, or a joint that swells quickly after a cut or bite. These can be infection.
Common questions
How do I know it’s not rheumatoid arthritis?
Osteoarthritis mainly affects the end and middle finger joints and the thumb base, with hard bony lumps and short morning stiffness. Rheumatoid arthritis tends to cause soft swelling of the knuckles at the base of the fingers and wrists, with long morning stiffness. Your GP can check with blood tests if unsure.
Do thumb splints work?
Yes, if you give them time. They don’t do much in the first few weeks, but worn for several months they ease pain and improve function.
Will the bony lumps go away?
The lumps are bone and usually stay, but they’re harmless, and keeping your hands moving still helps.
Should I have a steroid injection in my thumb?
Good trials found thumb-base injections no better than a dummy injection. A splint, exercises and gel are better first steps.
Helpful resources
- MyOA (Arthritis Australia)Trusted osteoarthritis information, plus symptom tracking and goal-setting tools. Free, Australia.
- Arthritis AustraliaInformation sheets and the free Arthritis Infoline (1800 011 041) for questions and local support. Free, Australia.
Evidence and more information
- RMD Open: Evidence review for the EULAR hand osteoarthritis recommendations (2018)
- Lancet (2019): Prednisolone for inflamed hand osteoarthritis (HOPE trial)
- Annals of Internal Medicine (2018): Hydroxychloroquine for hand osteoarthritis (HERO trial)
- NICE: Osteoarthritis diagnosis and management (2022)
maladywise.com/hand-oa/