Hand & Wrist OA

Hand and wrist osteoarthritis (OA) causes gradual pain, stiffness and weakness of grip, and is one of the most common forms of OA in older adults.

It mainly affects 3 joint groups: the distal interphalangeal (DIP) joints, the proximal interphalangeal (PIP) joints and the thumb base, the first carpometacarpal (CMC1) joint. Erosive OA is a more aggressive, inflammatory subset.

Wrist OA is less common and is usually post-traumatic, after scaphoid non-union, scapholunate ligament injury or distal radius malunion, or part of inflammatory disease. The diagnosis is usually made clinically.

The hand pattern is characteristic:

• •DIP joints: Heberden's nodes (dorsolateral bony swellings)
• •PIP joints: Bouchard's nodes
• •Thumb base: squaring from osteophytes and dorsoradial subluxation of the metacarpal
• •Metacarpophalangeal (MCP) joints: typically spared in primary hand OA

The CMC1 is a saddle joint stabilised by ligaments including the anterior oblique (beak) and dorsoradial ligaments. Load is concentrated there: a pinch at the thumb tip is magnified about 12 times at the joint.

Erosive OA causes central 'gull-wing' erosions of the DIP and PIP joints and episodes of warm, tender joints.