Arthritis

Hand arthritis is extremely common and develops as the protective cartilage between joints gradually wears down. Some people experience stiffness; others notice pain with gripping, pinching, or fine motor tasks. Two areas are affected most often:

The thumb carpometacarpal (CMC) joint, also known as the basal joint
The distal interphalangeal (DIP) joints, the small joints near the fingertips

These conditions can be frustrating, but with the right approach, most patients achieve significant, long-lasting relief.

Thumb CMC (Basal Joint) Arthritis

This is the most common form of hand arthritis I treat. The basal joint provides the thumb’s essential pivoting and pinching motion. When it becomes arthritic, daily tasks become surprisingly difficult.

Symptoms of CMC Arthritis

Typical symptoms include:

Pain at the base of the thumb
Difficulty opening jars, turning keys, or gripping objects
Pain with pinching (e.g., zipping a coat)
Swelling or a visible bump at the base of the thumb
Weakness when grasping
Morning stiffness

Symptoms may come and go before becoming more persistent.

Why CMC Arthritis Happens

The basal joint is one of the most mobile joints in the body, and over years of use, its cartilage can wear down.

Contributing factors include:

Genetic predisposition
Hyperlaxity or generalized ligament looseness
Prior thumb injuries
Repetitive thumb-intensive activities
Age and hormonal factors (especially in women)

Daily life requires the thumb to function constantly — so even mild arthritis can be noticeable.

How We Diagnose CMC Arthritis

Diagnosis is based on:

A careful history of your symptoms
Physical exam focusing on joint stability, range of motion, and tenderness
X-rays to assess progression and alignment

The exam helps distinguish CMC arthritis from tendonitis or nerve compression, which can mimic similar pain patterns.

Treatment Options for CMC Arthritis

Most people find relief with nonsurgical treatment.

Nonsurgical Options

Activity modification
Heat or ice depending on your symptoms
NSAIDs (when medically appropriate)
Specialized bracing — soft or rigid options that support the CMC joint
Targeted corticosteroid injection for flare-ups
Hand therapy to improve biomechanics, strength, and comfort

Many patients do extremely well without surgery.

Surgical Options

When pain persists despite nonsurgical care, surgery can provide durable relief. I offer:

Denervation

A minimally-invasive technique where your anatomy is not changed, but the nerves that collect pain signals from the joint are surgically disrupted. This can take the edge off the pain. It is not like an "off switch" entirely, but it can provide good pain relief in many cases that can last 1-2 years.

CMC Arthroplasty / Suspensionplasty

This is a tried-and-true technique, removing the arthritic bone and using one of a variety of accepted techniques to stabilize the thumb joint.

Suture Suspensionplasty in particular uses modern implants or suture constructs to maintain thumb height and stability without tendon harvest. It often allows quicker recovery than a traditional tendon-harvesting LRTI.

CMC Fusion (Arthrodesis)

Reserved for younger patients with heavy hand demands; provides powerful stability but eliminates motion at that joint.

The choice depends on anatomy, activity level, goals, and radiographic findings.

Recovery After CMC Surgery

Recovery is steady and predictable, but it can take several months:

Early gentle motion begins quickly
Splinting or a brace is used during early healing
Therapy helps restore strength and movement
Most daily activities resume within a few weeks
Full strength returns over several months
Pain relief is typically excellent, after the surgical pain wears off.

DIP Osteoarthritis (Heberden’s Nodes)

The distal interphalangeal (DIP) joints — the ones closest to the fingertips — commonly develop osteoarthritis. This leads to:

Bony bumps known as Heberden’s nodes
Swelling
Tenderness
Intermittent flares
Reduced motion or deviation of the fingertip
Cosmetic changes that some patients find bothersome

While DIP arthritis rarely threatens function in a major way, it can be painful and annoying.

Symptoms of DIP Arthritis

Patients often notice:

Pain with pinch or fingertip pressure
Sharp pain during flares
Stiffness in the morning
Visible bumps that enlarge gradually
Crooked fingertips as the joint settles into a new alignment
A small cyst called a Mucous Cyst can appear near an arthritic DIP joint

Flares can feel disproportionately painful given the size of the joint.

Treatment Options for DIP Arthritis

Nonsurgical Management

Most DIP arthritis is managed successfully with:

Topical anti-inflammatory gels
Heat or warm water soaks
Short courses of oral anti-inflammatories (if safe)
Finger sleeves or silicone supports
Periodic corticosteroid injections (for severe flares)

These measures reduce pain and swelling and allow patients to function comfortably.

Surgical Options (When Needed)

When DIP arthritis causes constant pain or significant deformity, surgery can help.

One option is:

DIP Denervation

A small outpatient procedure
Cuts/burns the nerves that collect pain signals from the joint
A pain procedure only, that does not affect/improve bony deformity
Preserves strength at the fingertip

This option can provide some pain relief, but it is not always predictable or permanent.

DIP Joint Fusion (Arthrodesis)

A small outpatient procedure
Stabilizes the joint in a functional position
Eliminates pain and deformity
Preserves strength at the fingertip

Patients regain predictable, pain-free pinch.

In cases where there is a Mucous Cyst, a small bubble or joint fluid near the nail, patients may elect to proceed with:

Mucous Cyst Excision

A small outpatient procedure
Does not eliminate arthritis
Designed to remove the cyst coming from the arthritic joint
Small, 1-2 cm incision
Preserves strength at the fingertip
Pain from arthritis can persist, deformity from arthritis will persist - these are not addressed in a cyst surgery.

My Approach to Hand Arthritis

Whether the arthritis affects the thumb base or the fingertip joints, my approach is centered on:

Clear diagnosis
Thoughtful discussion of options
Starting with conservative measures
Offering surgery when it will genuinely improve quality of life
Precision, stability, and careful postoperative guidance

Hands are deeply personal. My priority is to help you regain comfort, confidence, and function in the activities that matter to you — from everyday tasks to fine motor work or hobbies.