Hand condition guide
Arthritis in the small joints of the fingers can cause pain, stiffness, swelling and changes in shape. These can make gripping, pinching and everyday tasks harder. This guide explains the three finger joints and how arthritis in them is assessed. It also covers the options Mr Alistair Jepson discusses with patients, from hand therapy, splints and image-guided injections to fusion, joint replacement and PIP joint denervation.
Written by Mr Alistair Jepson
Consultant Orthopaedic Surgeon · GMC 4104128
Each finger bends at three joints. Smooth cartilage covers the ends of the bones so they glide easily. In arthritis this cartilage wears or becomes inflamed. The joint can then become painful, stiff, swollen or unstable.
Osteoarthritis
Wear of the joint cartilage. It most commonly affects the DIP and PIP joints and often runs in families.
Inflammatory arthritis
Conditions such as rheumatoid arthritis, where inflammation damages the joint. The MCP joints are often affected.
After an injury
An old fracture or dislocation into a joint can lead to arthritis in that joint, sometimes years later.
Arthritis at the base of the thumb behaves differently and has its own guide: thumb base (CMC) arthritis.
Symptoms often come and go, with flare-ups lasting days or weeks. One finger or several may be affected. The pattern can also differ between the end, middle and knuckle joints.
An ache in the joint, often worse with gripping, pinching or after heavy use, and sometimes at night.
Fingers that feel stiff, especially first thing in the morning, with puffy or warm joints during a flare.
Firm nodes over the joint: Heberden's nodes at the DIP joint and Bouchard's nodes at the PIP joint.
Small fluid-filled cysts beside an arthritic DIP joint, sometimes causing a groove in the nail. They are a type of ganglion cyst.
A finger may angle or twist at a worn joint. In inflammatory arthritis the fingers can drift at the knuckles.
Difficulty with jars, keys, buttons and writing, because a painful or unstable joint cannot take load.
Most finger arthritis can be diagnosed at a single consultation. The aim is to understand which joints are causing the problem, how they affect your hand and what matters most to you.
Mr Jepson asks about your symptoms, your work, hobbies and daily tasks, any previous injuries, and any family history of arthritis.
Each joint is checked for movement, stability, swelling, tenderness and alignment. Your grip and pinch are also checked.
X-rays show joint space narrowing, bony spurs and alignment, and help plan treatment for each joint. More on X-rays and other scans is on the imaging and scans page.
If an inflammatory arthritis such as rheumatoid arthritis is suspected, blood tests are arranged. Mr Jepson works with a rheumatologist so the underlying condition is treated alongside your hand.
Hand therapy is the foundation of treatment for finger arthritis, and many people manage well without surgery. A hand therapist shows you how to protect painful joints and keep your fingers moving and strong. They will also help you decide whether a splint would help.
These measures do not reverse arthritis. They can ease pain, reduce flare-ups and help you keep doing the things that matter to you.
Simple changes reduce strain on sore joints, such as thicker-handled tools, jar openers and spreading load across the whole hand.
Gentle exercises, tailored by your hand therapist, keep each joint moving and maintain grip and pinch strength.
A small splint can rest a painful joint or support one that is drifting, during activity or at night. Splints are optional and not everyone needs one. See how to wear a finger splint.
Regular simple painkillers or anti-inflammatory gels can help during flare-ups. Check with your GP or pharmacist that they suit you.
Your hand therapist will make or fit your splint and show you how to wear it. As a general guide:
Wear it when advised
This is often during heavier tasks, or at night to rest the joint. Your therapist will tell you how long to wear it each day.
Position the finger
Slide the splint on so the painful joint sits snugly inside it, in the position your therapist set. Leave the other joints free unless you have been told otherwise.
Fasten it snugly, not tightly
Straps or tape should hold the splint in place without digging in. You should be able to slide a fingertip under the strap.
Check your skin
Each time you take the splint off, look for red marks or rubbing. Any marks should fade soon afterwards.
Take it off to wash and exercise
Keep the skin and the splint clean and dry. Keep doing the movement exercises your therapist gave you, so the joints do not stiffen.
Take the splint off and contact your hand therapist or the practice if your finger becomes numb, tingly, pale or more painful. Do the same if the splint rubs or no longer fits.
The finger joints are very small, so injections are given using ultrasound or X-ray guidance. This lets the steroid be placed accurately inside the joint rather than in the tissues around it.
A steroid injection can calm inflammation and ease pain, which may make hand therapy and daily tasks more comfortable. It does not repair worn cartilage. How much it helps, and for how long, varies from person to person. If an injection helps, it can be repeated, usually several months apart.
Find out how guided injections are carried out on the imaging and scans page.
When the end joint stays painful despite non-surgical care, fusion is the main surgical treatment. The worn joint surfaces are removed and the two bones are held together so they heal as one.
A small incision is made over the joint. The bones are then fixed straight or slightly bent, using a small screw or fine wires.
A stable, pain-free fingertip that can push firmly against the thumb for pinch. A finger that had drifted is also straighter.
The end joint no longer bends. Because the middle and knuckle joints keep moving, most people find this loss is well tolerated.
If a mucous cyst sits beside the joint, it can usually be dealt with during the same operation.
The middle joint matters a great deal for grip. The choice of operation depends on which finger is affected, how stable and well aligned the joint is, and how much movement it still has.
Main option
The worn joint surfaces are replaced with a small implant to relieve pain while keeping movement. This can be a flexible Silastic (silicone) implant. Replacement is often favoured in the middle, ring and little fingers, where bending matters for grip and side-to-side forces are lower.
If unstable or deformed
The joint is fixed at an angle chosen for that finger. Fusion suits a joint that is unstable, badly damaged or deformed. It is often preferred in the index finger, which needs strong side-to-side pinch against the thumb.
If movement is good but painful
This is for a painful joint that still has a good range of movement. The small nerve branches that carry pain from the joint are divided. Movement is kept, nothing is implanted and recovery is quick. Replacement or fusion remain open later if needed.
PIP joint replacement
A Silastic implant is a one-piece, flexible implant made of medical-grade silicone. It has a stem at each end and a hinge in the middle that bends as the finger moves. Each stem sits in the hollow centre of the bone on either side of the joint.
The implant is not glued or fixed to the bone. Instead, it acts as a flexible spacer. Over the following weeks the body forms a firm layer of tissue around it, which helps to support the new joint. Silicone implants have been used in the finger joints for many decades.
The knuckle joints let the whole finger bend and spread, so surgery here usually aims to keep that movement. Knuckle arthritis is often linked to inflammatory arthritis, so treatment is planned with your rheumatology care in mind.
Main option
The damaged knuckle joint is replaced with an implant, usually a flexible silicone (Silastic) implant of the same one-piece design. This relieves pain and keeps knuckle movement. Where the fingers have drifted, the soft tissues around the joint can be rebalanced at the same time to help straighten them.
If unstable
Sometimes a knuckle joint is too unstable to support a replacement. Fusing it at a functional angle then gives a stable, pain-free base for the finger, at the cost of knuckle movement.
A quick summary of the surgical options for each joint. Hand therapy, splints and guided injections are tried first for all three.
| Joint | Main options | When fusion is used | What movement is kept |
|---|---|---|---|
| DIP end joint |
Fusion is the main operation. | For a painful, worn or unstable end joint. It is the standard surgical treatment here. | The end joint no longer bends. The PIP and MCP joints keep moving as before. |
| PIP middle joint |
Joint replacement, including Silastic (silicone) implants; denervation when movement is good; fusion. | If the joint is unstable, badly damaged or deformed. Also in the index finger, where strong side pinch is needed. | Replacement aims to keep a useful arc of movement. Denervation keeps the movement you already have. Fusion fixes the joint at a set angle. |
| MCP knuckle joint |
Joint replacement, usually with a Silastic (silicone) implant. | If the joint is unstable. | Replacement aims to keep knuckle movement. Fusion fixes the knuckle at a set angle. |
This is a general guide. The right choice for you depends on your joints, your hand and your goals. Mr Jepson will talk through the options at your consultation.
Before any fusion, replacement or denervation, Mr Jepson talks through the benefits, risks and alternatives. The practice uses Concentric, a secure digital consent system, so you can read about your operation at home, ask questions and record your decision. Consent is confirmed again on the day. Read more in your day of surgery guide.
Finger joint operations are usually done as a day case under a regional block, which numbs the arm. You go home the same day. What happens at the hospital is explained in your day of surgery.
The finger is protected in a splint for several weeks until the bones join, which is checked on X-ray. Use of the hand then builds up gradually, with hand therapy if needed.
Movement starts early under the guidance of a hand therapist. Over the following weeks, a splint protects the new joint between exercises.
Nothing is implanted and the bone is not operated on. The finger can usually be moved straight away, with a return to light use within days.
These timings are typical. Your own recovery will depend on the joint, the operation and your work and activities. Wound care, swelling, pain relief and when to get in touch are covered in aftercare.
General answers to questions patients often ask about finger arthritis. Your own situation will be discussed at your consultation.
Most people do not. Many people manage well with hand therapy, joint protection, splints where helpful, simple pain relief and guided injections. Surgery is considered when pain continues despite these measures and affects daily life. It is also considered when a joint becomes unstable or badly deformed.
The PIP (middle) and MCP (knuckle) joints can be replaced, often with a flexible silicone implant. This is explained in Silastic (silicone) PIP joint replacement. The DIP (end) joint is small and needs to be firm for pinch, so fusion is the usual operation there. See the joint-by-joint comparison above.
There is no fixed lifespan. How long an implant lasts depends on the joint, the type of implant, the quality of the bone and ligaments around it, and how heavily the hand is used.
Silicone implants are flexible spacers, so over the years they can wear, tear or break. This does not always cause problems, because the firm tissue that forms around the implant often continues to support the joint. Some people notice the pain returning, the joint becoming looser or the finger starting to drift again.
If an implant wears out, it can usually be replaced with a new one, or the joint can be fused to give a stable, pain-free finger. Avoiding repeated heavy gripping and forceful twisting, as your hand therapist advises, helps protect the implant.
Mr Jepson will review your finger after surgery, with X-rays when needed. If new pain, swelling or a change in the shape of the finger develops later, please contact the practice for a review.
A replacement keeps movement, but it relies on the ligaments and bone around it to stay stable. Fusion gives a strong, stable, pain-free joint. It suits joints that are unstable, badly damaged or deformed, and the DIP joint. It also suits the index finger PIP joint, which takes strong side-to-side pressure when you pinch against the thumb. The trade-off is that the fused joint no longer bends.
Denervation divides the small nerve branches that carry pain signals from the joint. The nerves that give feeling to the finger are left intact. It suits people whose PIP joint is painful but still stable, with a good range of movement. It does not change the joint itself and nothing is implanted. Recovery is quick, and replacement or fusion can still be done later if needed.
They can ease pain and inflammation for a time, particularly during a flare. They do not repair cartilage, and the benefit varies between people. Injections into the small finger joints are given with ultrasound or X-ray guidance, usually several months apart. More detail is in the guided injections section above and on the imaging and scans page.
Call the practice on 01604 633730, or send an enquiry through the contact page. Mr Jepson sees patients at clinics in Northampton and Kettering. You can read more about Mr Jepson, or browse other hand and upper limb conditions. If you have previous X-rays or scan reports, please bring them with you.
Other hand guides that people with finger arthritis often find useful.
Call to arrange a consultation, book online for Circle Three Shires Hospital in Northampton, or send a short email and the practice team will come back to you.
Read independent patient reviews on Doctify (opens in a new tab), iWantGreatCare (opens in a new tab) or Google reviews (opens in a new tab)
