Osteoarthritis is wear of the cartilage that lines a joint. In the hand it favours the base of the thumb, the finger joints nearest the nails, the middle joints of the fingers and, after an old injury, the wrist. The joint aches with use, stiffens in the morning and slowly changes shape. It is common and it is not dangerous. Most people manage well for years with a splint, hand therapy and the occasional injection. Where that stops working there is an operation for every joint, all of them day procedures, and the right one depends on which joint is involved and what you need the hand to do.
What is osteoarthritis?
Smooth cartilage lets the two bones of a joint glide without friction. In osteoarthritis it thins and roughens, the joint space narrows and bone spurs form at the edges. The joint hurts under load, stiffens after rest and becomes more prominent.
The base of the thumb is the most common site and has its own page. The joints closest to the fingernails, the DIP joints, are next and are covered on the DIP joint osteoarthritis page. This page covers the rest: the middle joints of the fingers (PIP joints), the knuckles where the fingers meet the hand (MCP joints) and the wrist.
PIP joint arthritis produces firm swellings beside the middle joint and a stiff finger. MCP joint arthritis is less common, and several worn knuckles at once can point to another condition. Wrist arthritis almost always follows an injury and runs a predictable course, described on the SLAC and SNAC wrist page.
Symptoms
Most people describe:
- Pain in the joint with use, and an ache afterwards that is worse in the evening
- Stiffness first thing in the morning that eases within half an hour
- Firm, bony swelling beside a finger joint
- A joint that has become crooked or no longer fully straightens
- In the wrist, pain with loading and a loss of bend noticed when pushing up from a chair
Causes and risk factors
- Age and sex. More common from the fifties onwards and more common in women, particularly for the finger joints.
- Genetics. Finger joint arthritis runs strongly in families and usually affects both hands.
- Previous injury. The dominant cause of wrist arthritis. A scaphoid nonunion, a ligament tear or a fracture into the joint wears the wrist over years.
- Other conditions. Gout, haemochromatosis and inflammatory arthritis damage hand joints in their own patterns and are managed differently.
Ordinary hand use does not cause it.
How it is diagnosed
By examination and an X-ray. We look at which joints are involved, how they line up, how far they move and what hurts on loading. The pattern matters: wear at the thumb base and the DIP joints is typical osteoarthritis, while several swollen knuckles or both wrists point towards inflammatory arthritis.
The X-ray shows how far the joint has worn and whether its neighbours are involved. For the wrist, a CT scan is sometimes added to map which parts of the joint are still healthy. Radiographic severity and symptoms often disagree. We treat what you can no longer do, not the film.
Non-surgical treatment
Many people never need anything more.
Joint protection, splinting and hand therapy
Wider grips on tools, lever taps and a jar opener take load off a worn joint. A small splint across a painful finger joint, or a wrist splint for heavier tasks, rests the joint during what aggravates it, and for the wrist that is often all that is needed for years.
GRIP Hand Therapy is on site at Eastwood and at Morphett Vale, and no referral is needed. The therapists fit the splint, manage swelling, keep stiff joints moving and strengthen the muscles that support them.
Medication and injections
Anti-inflammatory gel rubbed into a finger joint helps and has few side effects.
A corticosteroid injection into a joint can settle a flare and buy months of comfort. It does not repair the joint and the benefit usually wanes. We arrange these under ultrasound guidance rather than injecting in the rooms, because the joints are small and placement decides whether it works, and we would not repeat one more than twice in the same joint.
When surgery is needed
Surgery is for a joint that limits what you do despite the measures above. The worn surface is where the pain comes from, so it is removed, replaced or fixed so that it no longer moves, and which of those is right depends on the joint.
The operation
Joint replacement suits the MCP and PIP joints of the fingers, where movement matters most. The worn surfaces are removed and replaced with an implant, usually silicone. It is a day procedure under a general anaesthetic with a local anaesthetic for comfort afterwards, and takes about 45 minutes per finger. The aim is pain relief with useful movement, and a replaced joint does not move as much as a healthy one. It is described in full on the finger joint replacement page.
Joint fusion fixes the two bones together so the joint no longer moves and no longer hurts. It is the standard operation for the DIP joint, and the sound choice for the index finger PIP joint and the thumb MCP joint, which need stability for pinch more than movement. A finger joint fusion uses a screw or a plate, takes 30 to 45 minutes and is a day procedure under sedation or a general anaesthetic with local anaesthetic.
The wrist has a range of operations and the choice depends on which parts of the joint are still healthy. Where the wear is confined to one area, the worn bones can be removed or part of the wrist fused while the rest keeps moving, which keeps about half of normal wrist movement. Where the whole joint is worn, a total wrist fusion gives a strong, pain free wrist that no longer bends but still rotates. All are described on the SLAC and SNAC wrist page.
Recovery, week by week
Indicative, because it differs with the joint and the operation.
Day of surgery. Home the same day. Fingers may feel numb for one to three days from the local anaesthetic.
Days 1 to 7. Keep the dressing clean, dry and elevated. The hand therapist fits a custom made removable splint. After wrist surgery a plaster stays on.
Two weeks. Review and suture removal. Finger joint replacements start guided movement out of the splint. Fusions stay splinted.
Four to six weeks. Finger joint replacements are weaned from the splint, with buddy taping from four weeks and no splint by six. Finger fusions stop splinting at six weeks. Wrist fusions stay in a cast or splint for 6 to 8 weeks.
Six to twelve weeks. An X-ray confirms a fusion has united, usually by 8 to 12 weeks. Strengthening begins.
Driving and work. After a finger operation, driving and office work once out of the splint at 2 to 6 weeks, light manual work at 6 to 8 weeks, heavy work at 3 months. After wrist surgery allow 3 to 4 months for heavy work.
Risks and complications
These operations are routine and complications are uncommon. They can include:
- Wound healing problems or infection. Usually superficial and treated with antibiotics.
- Nerve injury. Numbness in a patch of skin over the back of a finger or hand, which often recovers.
- Stiffness. The main risk after a joint replacement, and why therapy starts early.
- Nonunion. A fusion that does not knit, more likely in smokers, which may need a further operation.
- Implant problems. A finger implant can wear or loosen over years and may need revision.
- Bruising, ongoing tenderness, swelling or slower than expected recovery.
When to be seen sooner
Contact us, or see your GP, if you have:
- A joint that is hot, red and swollen rather than aching, which needs infection or gout excluded
- Several knuckles or both wrists becoming painful and swollen over a few weeks
- Wrist pain after a fall that has not settled in two weeks, which may be a fracture
If you have had surgery with us and have questions or concerns afterwards, phone the rooms during office hours on (08) 7127 0365.
Frequently asked questions
Is osteoarthritis the same as rheumatoid arthritis?
No. Osteoarthritis is wear of the cartilage, local to the joints that have worn. Rheumatoid arthritis is an autoimmune disease that involves the knuckles and wrists on both sides and is treated by a rheumatologist. See the rheumatoid arthritis page.
Should I have a fusion or a replacement?
It depends on the joint. The DIP joint, the index finger PIP joint and the thumb MCP joint are better fused, because stability for pinch matters more than movement there. The other MCP and PIP joints are better replaced, because losing movement there costs you a fist. We decide together at the consultation.
Can an injection cure it?
No. An injection settles a flare and the comfort usually lasts months, which can be exactly what is needed. It does not repair cartilage.
How long does the operation take, and will I be awake?
A finger joint replacement takes about 45 minutes per finger under a general anaesthetic. A finger joint fusion takes 30 to 45 minutes under sedation or a general anaesthetic. Wrist operations take 60 to 120 minutes under a general anaesthetic. All are day procedures.
What does the surgery cost?
You will receive written informed financial consent setting out the surgeon, anaesthetist and hospital fees, your Medicare rebate and your health fund's contribution before anything is booked. Phone the rooms on (08) 7127 0365 for an estimate.
Do I need a referral?
A referral from your GP or another specialist means you can claim a Medicare rebate on the consultation with a surgeon. We can see you without one, but the rebate will not apply. No referral is needed for GRIP Hand Therapy.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 8 November 2026