Finger Arthritis

Other Names

• DIP arthritis
• Distal interphalangeal joint arthritis
• PIP arthritis
• Proximal interphalangeal joint arthritis
• MCP Arthritis
• Metacarpophalangeal joint arthritis
• Finger osteoarthritis

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Background

• This page describes all forms of arthropathies to the Metacarpophalangeal Joint, Proximal Interphalangeal Joint, and Distal Interphalangeal Joint

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Pathophysiology

• Main: Osteoarthritis
• DIP more commonly affected than PIP

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Risk Factors

• Rheumatoid Arthritis
• Inflammatory Arthropathies
• Trauma
• Gout

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Differential Diagnosis

• Fractures
  • Phalanx Fractures (Hand)
  • Metacarpal Fractures
    • Boxer's Fracture
    • Rolando Fracture
    • Bennett Fracture
• Dislocations
  • Metacarpophalangeal Joint Dislocation
  • Proximal Interphalangeal Joint Dislocation
  • Distal Interphalangeal Joint Dislocation
  • Carpometacarpal Joint Dislocation
• Tendinopathies
  • Extensor Tendon Injuries (Hand)
  • Central Slip Extensor Tendon Injury
  • Flexor Tendon Injuries (Hand)
  • Boutonniere Deformity
  • Swan Neck Deformity
  • Jersey Finger
  • Mallet Finger
  • Trigger Finger
  • De Quervains Tenosynovitis
  • Volar Plate Avulsion Injury
  • Sagittal Band Injury
• Ligament Injuries
  • Gamekeepers Thumb (UCL)
  • Radial Collateral Ligament of the Thumb Injury (RCL)
• Neuropathies
  • Wartenbergs Syndrome
  • Carpal Tunnel Syndrome
  • Guyon Canal Syndrome
• Arthropathies
  • Carpometacarpal Arthritis
  • Finger Arthritis
  • Rheumatoid Arthritis
• Nail Bed Injuries
  • Nail Bed Lacerations
  • Nail Bed Avulsions
  • Subungual Hematoma
  • Paronychia
  • Felon
• Pediatric Considerations
  • Proximal Phalanx Avulsion Fracture (Thumb)
  • Middle and Distal Phalanx Avulsion Fracture
• Other
  • Dupuytrens Contracture

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Clinical Features

• General: Physical Exam Hand
• History
  • Patient will endorse pain, swelling, possibly deformity
  • May have history of injury earlier in life
• Physical exam
  • Swelling (chronic), tenderness of affected joint(s)
  • Loss of range of motion
  • Bouchard's Node: hard, bony swelling of PIPJ
  • Heberden's Node: hard, bony swelling of DIPJ

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Evaluation

• Standard Radiographs Hand
  • Sufficient to make diagnosis
  • In cases of unclear etiology, rheumatological workup may be indicated

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Classification

• N/A

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Management

Nonoperative

• First line treatment
• Symptom management
  • Splinting
  • Medications: NSAIDS, Acetaminophen
  • Procedures: Corticosteroid Injection
  • In patients with RA, DMARDS are a consideration

Operative

• MCPJ
  • Indications: failed conservative measures
  • Procedures: K-wire and tension bands, arthrodesis, arthroplasty
• PIPJ
  • Indications: angular deformity affecting ADL, loss of function, debilitating pain
  • Procedure: Fusion, arthroplasty
• DIPJ
  • Uncommon, indicated for debilitating pain
  • Procedure: Fusion

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Return to Play

• Not commonly seen in athletes
• In adults interested in sport, restrictions vary with patient but are generally symptom base

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Complications

• Chronic pain
• Loss of ADLs

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See Also

• Hand and Wrist Anatomy (Main)
• Finger Pain (Main)
• Hand Pain (Main)
• Physical Exam Hand
• Osteoarthritis (Main)

External

• Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/

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