By Dr. Pedro Loredo, MD Hand Surgeon
Medically reviewed by Dr. Pedro Loredo, MD · Last reviewed: 2026-04-19
Hand and Wrist Arthritis Healthy joint vs arthritic joint, cross-section Healthy Joint Bone Smooth cartilage Wide joint space Arthritic Joint Bone-on-bone contact Osteophyte Eroded cartilage
Figure: in a healthy joint, smooth cartilage caps cushion the bones and a wide joint space allows full motion. In an arthritic joint, the cartilage erodes, the joint space narrows, bones grind on each other, and bone spurs (osteophytes) form at the joint margins.

Hand and wrist arthritis describes the loss of joint cartilage and the inflammatory or mechanical changes that follow. The three most common forms are osteoarthritis (the wear-and-tear pattern affecting the DIP, PIP, thumb CMC, and wrist), rheumatoid arthritis (an autoimmune disease that destroys joint cartilage and bone), and post-traumatic arthritis (the long-term consequence of an old fracture or ligament injury). Treatment ranges from anti-inflammatory medication, splinting, and corticosteroid injection to joint replacement (arthroplasty) or fusion (arthrodesis) for end-stage disease.

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The Anatomy of a Joint

How arthritis affects the hand showing the major affected joints (thumb CMC and finger joints) with red inflammation overlay. Bottom comparison shows healthy joint with intact cartilage and bone versus osteoarthritic joint with cartilage damage, joint space narrowing, and bone-on-bone contact. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
How arthritis affects the hand and the comparison between healthy and arthritic joint anatomy.

Cartilage caps the ends of every bone in a joint, providing a smooth gliding surface and cushioning load. The synovial membrane lines the joint and produces fluid that lubricates motion. In osteoarthritis, cartilage gradually wears away, the joint space narrows, bone rubs on bone, and osteophytes (bone spurs) form at the margins. In rheumatoid arthritis, an autoimmune attack on the synovial lining drives cartilage and bone destruction, often symmetrically and at multiple joints. In post-traumatic arthritis, an old fracture or ligament injury alters joint mechanics and accelerates cartilage wear at that specific joint.

The most commonly affected joints in the hand are the distal interphalangeal (DIP) joints, the proximal interphalangeal (PIP) joints, the thumb carpometacarpal (CMC) joint, and the wrist. The metacarpophalangeal (MCP) joints are most often involved in rheumatoid arthritis.

Clinical coding: ICD-10 M19.0 (primary osteoarthritis, multiple sites). M06.9 (rheumatoid arthritis, unspecified). SNOMED CT 396275006 (osteoarthritis), 69896004 (rheumatoid arthritis).

Causes and Risk Factors

  • Age: osteoarthritis risk rises steadily after 50
  • Female sex, particularly for DIP, PIP, and thumb CMC osteoarthritis
  • Family history, with a clear genetic component for both OA and RA
  • Prior trauma: fracture or significant ligament injury at the joint
  • Prior infection in the joint (septic arthritis)
  • Autoimmune disease: rheumatoid, psoriatic, lupus, gout
  • Repetitive heavy use in manual occupations
  • Smoking, which is a clear risk factor for rheumatoid arthritis severity

Symptoms and Warning Signs

  • Joint pain, often deep and aching, worse with use and at the end of the day
  • Morning stiffness (in RA classically more than 1 hour, in OA less than 30 minutes)
  • Joint swelling and warmth, more prominent in inflammatory arthritis
  • Loss of grip strength and difficulty with fine pinch
  • Visible nodules at fingertip joints (Heberden's) or middle finger joints (Bouchard's)
  • Joint deformity, including ulnar deviation of the fingers in advanced rheumatoid disease
  • Crepitus, a grinding sensation with motion
  • Loss of motion at the affected joint

Understanding Finger Arthritis Progression

Understanding finger arthritis progression illustration showing five stages from healthy joint with intact cartilage at stage 1 through progressive cartilage loss, bone changes, and complete bone-on-bone contact at stage 5 (arthritic joint). 3D hand model on the left for context. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
Finger arthritis progresses through five stages from healthy cartilage to bone-on-bone contact.

Finger arthritis develops gradually. Stage 1 shows a healthy joint with intact cartilage and full motion. Stage 2 begins with mild cartilage thinning, often without symptoms. Stage 3 brings noticeable joint space narrowing and the first symptoms of pain and stiffness. Stage 4 shows substantial cartilage loss with bone changes including osteophytes (bone spurs). Stage 5 is the end-stage arthritic joint with bone-on-bone contact, severe pain, and visible deformity. Treatment options expand at every stage, with conservative care effective in early stages and surgical reconstruction reserved for advanced disease.

How OA, RA, and Post-Traumatic Arthritis Differ

  • Onset: OA is gradual and age-related. RA can appear at any age, often in the 30s to 50s. Post-traumatic arthritis is linked to a specific past injury.
  • Pattern: OA is asymmetric and concentrates at DIP, PIP, thumb CMC, and wrist. RA is symmetric and concentrates at MCP, wrist, and PIP joints. Post-traumatic arthritis affects only the joint that was injured.
  • Morning stiffness: less than 30 minutes in OA, more than 1 hour in RA, variable after trauma.
  • Lab tests: normal in OA. RA shows positive rheumatoid factor, anti-CCP antibodies, and elevated inflammatory markers (ESR, CRP).
  • X-ray pattern: joint space narrowing and osteophytes in OA. Erosions and periarticular osteopenia in RA. Old fracture lines and joint incongruity in post-traumatic.

SLAC Wrist (Scapholunate Advanced Collapse)

SLAC wrist is a specific pattern of post-traumatic wrist arthritis that develops after an unrecognized or untreated scapholunate ligament injury. The torn ligament destabilizes the carpus, causing the scaphoid to rotate abnormally and load the joint surfaces unevenly. Over years, predictable cartilage wear progresses through three sequential stages.

Key symptoms of SLAC wrist arthritis listed: pain on dorsal-radial side of wrist worse with strong grip, reduced range of motion, weakness, swelling and tenderness over scaphoid and lunate, mechanical clicking and grinding, instability, visible deformity. Anatomical wrist illustration shows three osteoarthritis sites: stylo-scaphoid, radio-scaphoid, and capitolunate. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
SLAC wrist symptoms and the three classic osteoarthritis sites: stylo-scaphoid, radio-scaphoid, and capitolunate.

SLAC Wrist Conservative Treatment

SLAC wrist arthritis nonoperative treatments for early-stage disease listed: splinting and immobilization with wrist braces, NSAIDs (ibuprofen, naproxen), corticosteroid injections, activity modification, hot and cold therapy, nutritional supplements. Anatomical wrist illustration showing the arthritic joint pattern. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
Early-stage SLAC wrist conservative treatment ladder.

SNAC Wrist (Scaphoid Nonunion Advanced Collapse)

SNAC wrist is the post-traumatic arthritis pattern that develops after an unhealed (nonunion) scaphoid fracture. The persistent scaphoid fracture creates abnormal motion and uneven joint loading, producing predictable cartilage wear in three sequential types similar to SLAC but with distinct radiographic patterns.

SNAC (Scaphoid Nonunion Advanced Collapse) arthritis anatomy infographic showing key symptoms: chronic deep ache localized to the thumb side of the wrist and anatomical snuffbox, reduced grip and pinch strength, stiffness and reduced wrist extension and radial deviation, dorsal-radial swelling, pinpoint tenderness over scaphoid and scapho-trapezial-trapezoid area, clicking or crepitus. Three anatomical wrist models showing SNAC Type 1, Type 2, and Type 3 progression. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
SNAC wrist symptoms and the three sequential types of post-nonunion arthritis progression.

SNAC Wrist Conservative Treatment

SNAC wrist arthritis treatments listed: splinting with removable brace in neutral position, NSAIDs to reduce swelling and pain, corticosteroid injections into the joint, hand therapy with exercises to maintain range of motion. Anatomical wrist skeleton illustration. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
SNAC wrist conservative management approach.

How the Diagnosis Is Made

Diagnosis combines a focused history, joint-by-joint examination, X-ray, and selective laboratory testing.

  • History: timing, pattern of joint involvement, prior injury, family history, autoimmune disease.
  • Physical exam: joint tenderness, swelling, warmth, deformity, range of motion, crepitus, nodules, ligamentous stability.
  • X-ray: standard imaging. Joint space narrowing and osteophytes in OA. Erosions in RA. Old fracture or joint incongruity in post-traumatic disease.
  • Laboratory testing: rheumatoid factor, anti-CCP antibodies, ESR, CRP when RA is suspected. ANA panel for lupus. Uric acid for gout.
  • MRI is occasionally used to assess synovitis, soft-tissue involvement, or early erosions in RA when X-rays appear normal.
  • Joint aspiration when crystal arthritis (gout, pseudogout) or septic arthritis is in the differential.

Non-Surgical Treatment Options

  • Activity modification and joint protection education from a hand therapist
  • Splinting, particularly for thumb CMC and wrist arthritis. Custom splints during aggravating tasks and at night.
  • Hand therapy for range of motion, gentle strengthening, and ergonomic adaptation
  • Topical and oral nonsteroidal anti-inflammatory medication
  • Acetaminophen for patients who cannot tolerate NSAIDs
  • Corticosteroid injection, most useful for thumb CMC, wrist, and selective PIP/DIP joints. Generally limited to 2 to 3 injections per joint per year.
  • Disease-modifying antirheumatic drugs (DMARDs) and biologics for rheumatoid arthritis, prescribed and managed by a rheumatologist. These medications change the trajectory of RA and prevent the joint destruction that drives long-term hand deformity.
Treatment options for hand and finger arthritis infographic showing four conservative care categories: Medications (NSAIDs and steroids by mouth), Physical Therapy (hand therapist working with patient), Splints/Braces, Heat/Ice and Activity Accommodations, and Steroid Injections. Hand with arthritic joints highlighted in red on the right. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
Conservative treatment options for hand and finger arthritis: medications, physical therapy, splints, and steroid injections.

Surgical Options

Surgical treatment is matched to the affected joint, the stage of disease, and the patient's functional priorities. Dr. Loredo discusses each option in detail at consultation, including motion-preserving versus motion-eliminating choices.

Synovectomy

Surgical removal of inflamed synovial lining. Most useful in selected RA patients with persistent localized synovitis despite optimal medical therapy.

Finger Joint Surgery

Surgical treatment for arthritic finger joints (DIP and PIP) is matched to the specific joint and patient priorities. Fusion provides reliable pain relief by eliminating motion at the joint. Joint implants preserve motion at PIP joints.

Distal Interphalangeal (DIP) Joint Fusion

Distal interphalangeal (DIP) joint fusion X-ray sequence for arthritis surgical treatment showing the arthritic joint before surgery and after fusion with a small intramedullary screw maintaining bone-on-bone contact for solid healing. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
DIP joint fusion using a small intramedullary screw provides reliable pain relief.

DIP fusion is the workhorse procedure for end-stage DIP joint arthritis. The DIP joint provides only fine-tuning motion, so fusion eliminates pain without meaningful functional loss. A small intramedullary screw or pin holds the joint surfaces together while bone heals across the joint.

Proximal Interphalangeal (PIP) Joint Fusion

Proximal interphalangeal (PIP) joint fusion three-step procedure illustration showing the arthritic joint surfaces being prepared with a high-speed burr, the joint surfaces being drilled to expose bleeding bone for healing, and the final fixation with a compression screw across the joint. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
PIP joint fusion: surface preparation, drilling, and compression screw fixation.

PIP fusion is selected for end-stage PIP arthritis when reliable pain relief and stability matter more than retained motion. Most often used at the index finger PIP joint where lateral pinch stability is critical, and at any PIP joint with severe deformity.

PIP Joint Implants (Arthroplasty)

Joint implants of the proximal interphalangeal (PIP) joint for arthritis surgical treatment showing the PIP and MCP joint anatomy, two implant material options (silicone and pyrocarbon), how the implants are inserted into channels created in the bone, and the post-operative bandaged hand with splint. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
PIP joint implants preserve motion using silicone or pyrocarbon prosthetic components.

PIP joint implant arthroplasty preserves motion at the PIP joint while eliminating the arthritic joint surfaces. Silicone and pyrocarbon are the two primary implant materials. Best suited for the middle, ring, and small finger PIP joints (motion preservation is more functionally important than at the index finger). Particularly useful in rheumatoid patients.

Wrist Arthritis Surgery

SLAC and SNAC wrist arthritis surgical treatment overview describing motion-preserving procedures including proximal row carpectomy and four-corner fusion, total wrist fusion or arthroplasty for advanced cases, and earlier stage options including radial styloidectomy and denervation. Intraoperative photograph showing surgical exposure of the wrist with retractors. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
SLAC and SNAC wrist surgical treatment overview from joint-preserving to salvage procedures.

Early-Stage and Joint-Preserving Wrist Procedures

Radial Styloidectomy.

Radial styloidectomy for wrist arthritis surgical treatment showing the radial styloid bone being resected with two cuts shown on the carpal bones, typically used in early-stage SLAC or SNAC wrist disease. Anatomical models of the wrist demonstrate the surgical resection. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
Radial styloidectomy removes the prominent bony edge that contributes to early-stage SLAC or SNAC pain.

Removal of the radial styloid bone process to relieve impingement pain in early-stage (Stage I) SLAC or SNAC wrist disease. Often combined with other procedures.

Wrist Denervation.

Wrist denervation for wrist arthritis surgical treatment showing the small dorsal incision marked on the wrist (panel A) and the anatomical view of the radial nerve (R), ulnar nerve (U), and interosseous membrane (IOM) with red marks indicating the small nerve branches that are cut to interrupt pain signals to the wrist joint (panel B). Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
Wrist denervation interrupts pain-sensing nerves while preserving full wrist motion.

Selective division of the small sensory nerves that carry pain signals from the wrist joint. Preserves wrist motion completely. Used as a stand-alone procedure in select patients or combined with other procedures.

Distal Scaphoid Excision (SNAC-Specific).

Distal scaphoid excision for wrist arthritis surgical treatment specific to SNAC wrist showing the carpal bones with the scaphoid (S), capitate (C), hamate (H), and lunate (L) labeled. Red lines indicate the resection of the distal scaphoid fragment. The radial styloid is also shown resected. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
Distal scaphoid excision removes the unhealed scaphoid fragment in SNAC wrist arthritis.

Specific to SNAC wrist. Removes the distal portion of the unhealed scaphoid fragment that drives the abnormal joint motion and resultant arthritis. Preserves the proximal scaphoid and the rest of the wrist mechanics.

Motion-Preserving Wrist Reconstructions

Proximal Row Carpectomy (PRC).

Proximal row carpectomy (PRC) for wrist arthritis surgical treatment shown with before X-ray (A) of the arthritic wrist and after X-ray (B) showing the scaphoid, lunate, and triquetrum removed creating a new smoother articulation between the radius and the capitate. Often preferred for preserving wrist motion. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
PRC removes the proximal carpal row to create a new smoother joint between the radius and capitate.

Excision of the scaphoid, lunate, and triquetrum (the entire proximal carpal row), allowing the capitate to articulate directly with the distal radius. Preserves substantial wrist motion. Best suited for older or lower-demand patients with intact radio-capitate cartilage. Recovery is faster than four-corner fusion.

Scaphoid Excision and Four-Corner Fusion (4CF).

Scaphoid excision and four-corner fusion (4CF) for wrist arthritis surgical treatment three-panel illustration. Left: surgical exposure with screws holding bones together. Center: scaphoid excised and four-corner arthrodesis between capitate, lunate, hamate, and triquetrum shown. Right: completed fusion construct with circular plate fixation. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
Four-corner fusion preserves wrist motion at the radiolunate joint after scaphoid removal.

Removes the diseased scaphoid and fuses the remaining four bones of the proximal carpal row (capitate, lunate, hamate, triquetrum). Preserves the radiolunate articulation and approximately 50 to 60 percent of normal wrist motion. Provides reliable pain relief while maintaining functional motion. Often the preferred motion-preserving option for younger or higher-demand patients.

Salvage Procedures for End-Stage Wrist Arthritis

Total Wrist Arthrodesis (Total Wrist Fusion).

Total wrist arthrodesis (fusion) for wrist arthritis surgical treatment showing the wrist fusion plate construct on the left and the four surgical steps: preparation, distal fixation, compression, and final fixation across the wrist with a long dorsal plate. A salvage procedure for severe end-stage arthritis that eliminates motion to provide a pain-free, stable, strong wrist. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
Total wrist fusion: salvage procedure for severe end-stage arthritis providing pain-free strong wrist function.

Salvage procedure for severe, end-stage wrist arthritis that eliminates motion to provide a pain-free, stable, and strong wrist. Best for high-demand laborers and patients who prioritize strength over motion. The wrist fuses in a slight extension position that maximizes hand function.

Total Wrist Arthroplasty (TWA).

Total wrist arthroplasty (TWA) for wrist arthritis surgical treatment showing the modern third-generation total wrist joint prosthesis (top left), intraoperative photographs of the prosthesis being installed (top middle and right), and pre-operative through post-operative X-rays demonstrating the radial component, polyethylene insert, carpal component, and final reset of the artificial wrist joint. Modern implants offer 10 to 15 year longevity and dart-thrower motion preservation, used primarily for rheumatoid arthritis or severe osteoarthritis patients. Created for Loredo Hand Care Institute by Dr. Pedro Loredo.
Total wrist arthroplasty preserves motion using a modern third-generation prosthesis.

Replacement of the severely arthritic wrist joint with a modern third-generation prosthesis. Reduces pain while preserving motion (including the dart-thrower motion important for daily tasks). Modern implants offer 10 to 15 year longevity. Primarily used for rheumatoid arthritis patients or severe osteoarthritis patients who prioritize motion over the maximum durability of fusion.

Replacement vs Fusion: How We Decide Joint replacement preserves motion but is less durable, especially in heavy-use joints. Fusion is more durable and provides reliable pain relief but eliminates motion. The right choice depends on the specific joint, the disease pattern, the patient's age, and what matters most to that patient. We work through the options together at consultation.

Recovery Timeline

  • Corticosteroid injection: same-day return to most activity. Pain relief begins within 24 to 72 hours.
  • Synovectomy: 4 to 6 weeks of structured therapy. Custom splint as needed.
  • MCP or PIP arthroplasty: 6 to 12 weeks of structured hand therapy with a custom splint and dynamic motion protocol.
  • DIP or selective PIP fusion: 6 to 8 weeks in a finger splint until bony union is confirmed.
  • Thumb CMC arthroplasty (LRTI): 4 weeks in a thumb spica splint, then 4 to 8 weeks of progressive therapy.
  • Wrist procedures: 8 to 12 weeks in a cast or splint, then progressive therapy.

Returning to Work and Daily Activity

  • Office or desk work in a removable splint: within days to a week after most procedures
  • Light manual labor: 4 to 8 weeks depending on the operation
  • Heavy manual labor: 12 to 16 weeks
  • Driving: when grip strength and splint allow safe vehicle control, usually 2 to 6 weeks

Frequently Asked Questions

What is the difference between osteoarthritis and rheumatoid arthritis?

Osteoarthritis (OA) is mechanical wear-and-tear of joint cartilage. It usually starts after age 50, tends to be asymmetric, affects the fingertip and thumb-base joints most, and produces less than 30 minutes of morning stiffness. Rheumatoid arthritis (RA) is an autoimmune disease in which the immune system attacks the synovial lining of joints, eroding cartilage and bone. RA tends to be symmetric, affects the knuckle and wrist joints first, produces more than an hour of morning stiffness, and is diagnosed with blood tests showing rheumatoid factor and anti-CCP antibodies. The two conditions look similar on the outside but require very different treatment.

Are nodules at my fingertip joints serious?

Bony enlargements at the fingertip joints (DIP joints) are called Heberden's nodes and at the middle finger joints (PIP joints) are called Bouchard's nodes. They are a hallmark of osteoarthritis of the hand, appear over years, and are not dangerous. They can be unsightly and occasionally tender during a flare. Treatment focuses on managing pain, preserving function, and avoiding heavy gripping that aggravates the joints. Surgery is reserved for severely painful or unstable end-stage joints.

Does cracking my knuckles cause arthritis?

No. Multiple studies have looked specifically at this question and found no association between knuckle cracking and the development of arthritis. The popping sound is gas bubbles forming and collapsing within the joint fluid. It can become a habit, but it does not damage cartilage or accelerate joint wear.

When is joint replacement the right choice for hand arthritis?

Joint replacement (arthroplasty) is the right choice when joint pain is constant, conservative measures have failed, and motion preservation matters more than maximum stability. The MCP and PIP joints are the most common joints replaced in the hand, particularly in patients with rheumatoid arthritis. Thumb CMC arthritis is most often treated with trapezium excision and ligament reconstruction. Fusion (arthrodesis) is preferred at the DIP joint and for high-demand patients where pain relief and stability matter more than retaining motion.

Can hand arthritis be prevented?

Genetic risk for osteoarthritis cannot be changed. Post-traumatic arthritis can sometimes be prevented by prompt and accurate treatment of fractures and ligament injuries. Inflammatory arthritis is best prevented from progressing rather than from starting: early diagnosis and disease-modifying medication (managed by a rheumatologist) prevent the joint destruction that drives long-term hand deformity. For all forms, joint protection, regular activity, and avoiding tobacco are the most useful general measures.

When to Call the Doctor

Call our office for evaluation if you experience:

  • Joint pain that has lasted more than several weeks
  • Joint swelling that does not resolve within a week
  • Morning stiffness lasting more than 30 minutes
  • Symmetric joint involvement (suspect inflammatory arthritis)
  • Loss of grip or pinch strength that limits work or daily life
  • Visible joint deformity
  • A sudden flare with redness, warmth, and severe pain (suspect crystal or septic arthritis)

After surgery, call the office promptly if you experience:

  • Fever over 101°F, chills, or flu-like symptoms
  • Expanding redness or warmth around the incision
  • Thick, yellow, or foul-smelling drainage
  • Severe pain not controlled by prescribed medication
  • Sudden new finger numbness or inability to bend a finger

For any medical emergency, call 911 or go to the nearest emergency department.

Related Conditions

  • Thumb Basilar Joint Arthritis: the most specific and common form of hand osteoarthritis. Treated as a dedicated condition because the thumb base has unique reconstructive options.
  • Trigger Finger: often coexists with hand arthritis, particularly in patients with rheumatoid arthritis and diabetes.
  • Carpal Tunnel Syndrome: frequently coexists with rheumatoid arthritis due to synovial swelling within the carpal tunnel.
  • Hand and Finger Fractures: post-traumatic arthritis is a long-term consequence of fractures, particularly intra-articular distal radius and scaphoid nonunion.
  • De Quervain's Tendonitis: can be confused with thumb CMC arthritis. Differentiated by exam and selective injection.

From the Blog

Watch: Hand arthritis education

Short videos from Dr. Loredo's Instagram and Facebook channels.

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Dr. Loredo on recognizing and managing hand arthritis. View on Instagram.
A short reel on hand arthritis types and treatment. Watch on Facebook.

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