Understanding Hand Osteoarthritis
Updated: Sep 10
Osteoarthritis (OA) is the most common form of arthritis and one of the most common joint conditions worldwide. It involves gradual changes throughout the joint, including the cartilage, bone, synovium, ligaments, and surrounding tissues. Cartilage provides a smooth, low-friction surface that helps joints move efficiently. In osteoarthritis, changes throughout the joint may contribute to pain, stiffness, swelling, reduced mobility, and difficulty with everyday activities.
Hand OA most commonly affects:
The distal interphalangeal joints (DIP), the joints closest to the fingertips
The proximal interphalangeal joints (PIP), the middle finger joints
The carpometacarpal joint (CMC), at the base of the thumb
The base of the thumb is particularly vulnerable because of the substantial forces generated during gripping and pinching. Hand osteoarthritis becomes increasingly common with age and is more prevalent in women, particularly later in life.
Importantly, the structural changes seen on imaging do not always explain the full picture. Some people with significant changes on X-rays experience relatively little pain, while others with less extensive structural changes may experience considerable pain, stiffness, and limitations in function. To understand why, we need to look beyond the joint itself.
Seven Forces That Keep Hand Osteoarthritis Alive
Joint Load and Repetitive Mechanical Stress
The hands perform thousands of tasks every day. Pinching, gripping, typing, lifting, twisting, and tool use repeatedly load the small joints of the fingers and thumb. The thumb base is particularly exposed to substantial forces during gripping and pinching.
How these forces are distributed can be influenced by joint anatomy, previous injury, mobility, strength, and the way the hand is being used. However, mechanical stress alone does not explain hand osteoarthritis. Many people perform repetitive tasks for decades without developing significant symptoms, while others develop OA with no obvious history of excessive hand use. Hand OA is a multifactorial condition, and mechanical loading is only one part of the picture.
Loss of Motion and Increasing Stiffness
Pain and stiffness can lead people to use an affected hand less. Unfortunately, reduced use may contribute to further loss of mobility, strength, and confidence in movement, creating a cycle:
pain → guarding → reduced movement → increasing stiffness → greater difficulty using the hand
This is one reason regular movement and exercise are important in managing hand OA. Rather than trying to “protect” an arthritic joint by avoiding movement altogether, appropriately selected mobility and strengthening exercises can help maintain movement and function.
Soft Tissue Tension and Forearm Overload
The hand does not function in isolation. Many of the muscles that move the fingers originate in the forearm, with tendons crossing the wrist before reaching the fingers and thumb. The flexor muscles contribute to gripping, while the extensors help open and control the hand.
For this reason, a clinical assessment may extend beyond the painful joints to include the wrist, forearm, muscles, tendons, and other structures involved in hand function. When clinically appropriate, treatment may also address these areas as part of a broader approach to improving mobility and function.
Watch the accompanying video as Dr. Brian Abelson demonstrates his approach to hand osteoarthritis. The treatment incorporates Motion Specific Release (MSR) soft-tissue techniques, joint mobilization, and selected acupressure techniques alongside exercise and rehabilitation.
Nervous System Sensitivity
Pain does not always correspond directly to the amount of structural change within a joint. Pain is ultimately an experience produced by the nervous system in response to information from the body and many other influences.
In some people with persistent OA pain, the nervous system can become increasingly sensitive. This phenomenon, commonly discussed in relation to pain sensitization, may help explain why relatively small movements or loads can sometimes become painful even when structural findings alone do not fully explain the severity of symptoms.
This does not mean the pain is imaginary. It means that pain is influenced by both the condition of the tissues and the way the nervous system processes information. Gradual movement, exercise, education, and appropriate treatment can help people regain confidence in using their hands.
Loss of Strength and Grip Decline
When hand OA becomes painful, people often grip less forcefully and avoid activities that aggravate their symptoms. Over time, strength and functional capacity can decline, making everyday tasks such as opening jars, carrying groceries, turning keys, or using tools more difficult.
This is one reason strengthening exercises are an important part of hand OA rehabilitation. Research indicates that exercise-based rehabilitation can improve pain, function, stiffness, and grip strength, particularly in the shorter term. Strengthening is therefore not simply about building muscle. It is about maintaining the capacity to use the hands effectively in everyday life.
Inflammation
Osteoarthritis was once commonly described as simply “wear and tear,” but we now know that the biology is more complex. Inflammation within the joint, particularly synovitis, can occur in hand OA and is associated with pain and, in some cases, structural progression.
This does not mean that hand OA should be viewed in the same way as systemic inflammatory diseases such as rheumatoid arthritis. Rather, inflammation is one component of a complex condition involving cartilage, bone, synovium, ligaments, biomechanics, genetics, and other biological factors.
General health still matters. Regular physical activity, nutritious food, adequate sleep, avoiding smoking, moderating alcohol consumption, and maintaining good metabolic health support overall health and may also influence how people experience and manage osteoarthritis.
Fear and the “Wear and Tear” Narrative
Perhaps one of the most important influences on function is what people believe about their joints. Being told that a joint is “worn out” can create the impression that movement is causing further damage and should therefore be avoided.
For some people, this can lead to excessive protection of the hand. Movement decreases, strength declines, stiffness increases, and everyday activities become more difficult.
Structural changes do not necessarily mean that a joint is fragile or that movement should be avoided. Even with established osteoarthritis, people can often improve strength, mobility, function, and confidence through appropriately selected exercise and rehabilitation.
The goal is not to ignore pain or force a painful joint to move. It is to find the appropriate level of movement and gradually build from there.
Confidence in movement is not simply positive thinking. It is an important part of returning to function.
The Integrated Approach
Calm. Restore. Build.
Because many factors can influence pain and function in hand osteoarthritis, management rarely depends on a single intervention. Current clinical guidelines emphasize a combination of education, exercise, self-management, and other treatments selected according to the individual's symptoms and needs.
A useful way to think about rehabilitation is through three overlapping priorities: calm symptoms, restore movement and function, and build strength and resilience. These are not rigid stages. Depending on symptoms and activity levels, people may move back and forth between them.
Phase 1 – Calm the System
When joints are painful or highly irritable, the initial priority is often to reduce symptoms while maintaining comfortable movement. Gentle mobility exercises can help prevent unnecessary loss of motion, while heat, including warm water or paraffin, may provide temporary relief from pain and stiffness.
Manual therapy, soft-tissue techniques, and acupressure may also be incorporated when clinically appropriate to help manage symptoms and improve mobility. Sleep, stress management, and general physical activity are also important components of overall health and pain management.
The objective at this stage is not to push through significant pain or fatigue. It is to keep the hand moving while settling symptoms enough to progress.
Phase 2 – Restore Motion and Function
As symptoms become more manageable, rehabilitation can progressively emphasize movement and functional capacity. This may include:
Joint mobilization of the fingers, thumb, and wrist
Soft-tissue treatment of the hand and forearm
Mobility and dexterity exercises
Progressive grip and pinch exercises
Functional training for everyday activities
Exercise is widely recommended in international guidelines for hand OA and can improve pain, mobility, strength, and function. The objective is to gradually increase what the hand can comfortably do rather than simply eliminate every sensation before becoming more active.
Phase 3 – Build Strength and Resilience
Rehabilitation should ultimately extend beyond symptom relief. Progressive strengthening of the hands, wrists, and forearms can improve grip and pinch strength and increase the capacity to perform everyday activities. Depending on the individual, rehabilitation may also include the elbow, shoulder, and other parts of the upper extremity involved in functional movement.
Flare-ups can still occur. They do not necessarily mean that additional damage has occurred or that rehabilitation has failed. Sometimes they indicate that the amount or intensity of activity temporarily exceeded what the hand could comfortably tolerate. Adjusting the load and then gradually progressing again can help keep rehabilitation moving forward.
The goal is not a perfect hand. The goal is a resilient one.
Conclusion
Hand osteoarthritis is more than a cartilage problem. Pain and function can be influenced by many factors, including joint changes, mechanical loading, mobility, strength, inflammation, nervous system sensitivity, and how confidently the hands are being used.
These factors can interact, contributing to pain, stiffness, weakness, and reduced function. But persistent symptoms do not necessarily mean permanent loss of function. The hands remain remarkably adaptable.
By calming symptoms when necessary, restoring movement and function, and progressively building strength and resilience, many people can improve how their hands feel and what they are able to do.
The goal is not simply to reduce discomfort.
The goal is to help people keep using their hands for the things that make life meaningful.
References
Hennig T, Hæhre L, Hornburg VT, Mowinckel P, Norli ES, Kjeken I. Effect of home-based hand exercises in women with hand osteoarthritis: a randomised controlled trial. Annals of the Rheumatic Diseases. 2015;74(8):1501-1508.
Huang L, Zhang ZY, Gao M, Wang XQ, Duan XQ, Liu ZL. The effectiveness of exercise-based rehabilitation in people with hand osteoarthritis: a systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2024;54(7):457-467.
Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. The Lancet. 2019;393(10182):1745-1759.
Kloppenburg M, Kroon FPB, Blanco FJ, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Annals of the Rheumatic Diseases. 2019;78(1):16-24.
Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research. 2020;72(2):149-162.
Kroon FPB, Carmona L, Schoones JW, Kloppenburg M. Efficacy and safety of non-pharmacological, pharmacological and surgical treatment for hand osteoarthritis: a systematic literature review informing the 2018 update of the EULAR recommendations for the management of hand osteoarthritis. RMD Open. 2018;4(2):e000734.
Østerås N, Kjeken I, Smedslund G, Moe RH, Slatkowsky-Christensen B, Uhlig T, Hagen KB. Exercise for hand osteoarthritis. Cochrane Database of Systematic Reviews. 2017;(1):CD010388.
Rogers MW, Wilder FV. The effects of strength training among persons with hand osteoarthritis: a two-year follow-up study. Journal of Hand Therapy. 2007;20(3):244-249.
Terpstra SES, van de Stadt LA, Kloppenburg M. The management of hand osteoarthritis: the rheumatologist's perspective. Journal of Hand Therapy. 2022;35(3):322-331.
Zhang W, Doherty M, Leeb BF, et al. EULAR evidence-based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Annals of the Rheumatic Diseases. 2007;66(3):377-388.
About the Author: Dr. Brian Abelson, DC
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work focuses on musculoskeletal conditions, human movement, sports biomechanics, and evidence-informed approaches to treatment and rehabilitation.
He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
Continue Learning with MSR Courses and MSR Pro
For Healthcare Practitioners
Motion Specific Release integrates assessment, clinical reasoning, manual therapy, exercise, and patient education within one adaptable approach to musculoskeletal care.
MSR Pro and MSR courses support different parts of that learning process:
Structured Clinical Education: MSR courses connect applied anatomy and biomechanics with orthopedic and neurological assessment, myofascial procedures, fascial expansions, joint mobilization, manipulation, and rehabilitation.
Hands-On Skill Development: Live training provides opportunities to refine palpation, patient positioning, force application, and clinical decision-making through practice and direct feedback.
MSR Pro Clinical Library: Members receive access to more than 200 MSR procedures, downloadable and fillable clinical forms, examination resources, rehabilitation progressions, and exercise-prescription materials.
Extensive Video Resources: More than 800 videos support examination, treatment procedures, exercise rehabilitation, and clinical application.
Patient Education: A library of 50 condition articles helps practitioners explain common musculoskeletal problems and provide patients with practical information.
Continued Development: Resources are updated as MSR courses and clinical education continue to evolve.
Videos and articles can introduce concepts, but hands-on proficiency develops through deliberate practice, feedback, and experience. MSR is designed to help practitioners connect technique with clinical reasoning and adapt care to the individual rather than apply the same protocol to everyone.
Explore MSR Pro | View Online and Live Courses
Disclaimer:
The information provided on this website, including articles, videos, exercises, and other educational materials, is intended for general educational purposes and should not be considered a substitute for individualized assessment, diagnosis, or treatment by a qualified healthcare professional.
Musculoskeletal conditions vary considerably from person to person. An exercise, treatment, or technique that is appropriate for one person may not be appropriate for another. If you have pain, neurological symptoms, an injury, or concerns about your health, consult an appropriately qualified healthcare professional.
MSR manual treatment procedures intended for healthcare practitioners should only be performed by professionals with the appropriate training, qualifications, and scope of practice. Members of the public should not attempt professional manual treatment procedures based solely on information presented on this website.
Use of this website does not establish a healthcare provider-patient relationship. Please refer to our Terms of Use and full website disclaimer for additional information.
Comments