Why Your Hand Pain Isn’t “Just Arthritis”

The Hidden Differences Between CMC Arthritis, Tendonitis, and Nerve Compression**

Most people who develop hand pain — especially after age 40 — are told a familiar phrase:

“It’s probably just arthritis.”

Sometimes that’s true. But very often, it’s not.

Three common problems frequently masquerade as “arthritis,” and although they can feel similar at first, the treatments are completely different:

1. Thumb CMC (basal joint) arthritis

2. Tendonitis or tendon pulley problems

3. Nerve compression, including carpal tunnel syndrome

Being able to distinguish between these conditions is the key to getting the right treatment and avoiding months (or years) of unnecessary discomfort.

Below is a clear guide to why hand pain isn’t always “just arthritis,” and how I approach diagnosing and treating each condition.

1. Thumb CMC (Basal Joint) Arthritis:

Pain at the Base of the Thumb

The most common form of true arthritis in the hand occurs at the base of the thumb — the carpometacarpal (CMC) joint. This joint has an incredible range of motion, allowing us to pinch, grasp, and manipulate small objects. Because it’s used constantly, it can wear down over time.

Typical symptoms:

• Pain at the base of the thumb or along the wrist

• Difficulty opening jars

• Pain when turning keys or pinching

• Visible bump or swelling at the thumb base

• Weakness in grip strength

• Morning stiffness

What it feels like:

A deep, aching, grinding pain that gets worse with gripping or pinching — especially tasks like opening containers or twisting doorknobs.

Why it matters:

CMC arthritis is mechanical. It behaves predictably over time, and treatment progresses from bracing and injections to surgical reconstruction when conservative care isn’t enough.

👉 Learn more: Hand Arthritis (CMC/DIP)

2. Tendonitis and Triggering:

Pain in the Palm or Along a Finger, With or Without Clicking

Another category of hand pain comes from the flexor tendons — the structures that bend your fingers. When these tendons become inflamed and irritated, they no longer glide smoothly through their pulleys.

Common tendon problems:

• Trigger finger (catching or locking when bending the finger)

• Flexor tendon irritation

• Repetitive strain from tools or keyboard use

Typical symptoms:

• Pain in the palm, often at the base of a finger

• Clicking or catching when moving a finger

• Locking in a bent position

• Tender lump or “nodule” in the palm

What it feels like:

Sharp or catching pain with certain motions — very different from the deep ache of CMC arthritis. Many patients tell me they feel like “something is stuck inside the finger.”

Why it matters:

Tendon problems respond extremely well to:

• Activity adjustments

• Anti-inflammatory medication

• Targeted corticosteroid injections

• When needed, a small outpatient release

These problems do not require arthritis surgery, and calling them “just arthritis” delays a simple, effective solution.

👉 Learn more: Trigger Finger

3. Nerve Compression:

Tingling, Numbness, and Nighttime Pain

Not all hand pain originates from joints or tendons. One of the most overlooked culprits is nerve compression — most commonly carpal tunnel syndrome.

When the median nerve is compressed at the wrist, symptoms often spread into the hand and mimic arthritis.

Typical symptoms:

• Numbness or tingling in the thumb, index, and middle fingers

• Nighttime pain or waking from sleep

• “Shaking the hand out” for relief

• Hand weakness or dropping objects

• Aching along the wrist or palm

What it feels like:

A combination of pins-and-needles, burning, or a dull ache — often worst at night or during activities that flex the wrist.

Why it matters:

Nerve problems require completely different treatment than arthritis. If left untreated long enough, nerve compression can cause lasting numbness or muscle weakness.

👉 Learn more: Carpal Tunnel Syndrome

Why These Distinctions Matter

Even though CMC arthritis, tendon problems, and nerve compression can all cause hand pain, the origin of the pain is completely different — and so are the solutions.

A patient with:

• CMC arthritis may improve with a supportive brace, therapy, or eventually CMC arthroplasty.

• Trigger finger often responds beautifully to a simple steroid injection or small release.

• Carpal tunnel syndrome may need bracing, nerve gliding, or minimally invasive nerve release.

When everything gets labeled “arthritis,” the right treatment gets delayed.

How I Diagnose Hand Pain

My evaluation typically includes:

• A careful history: When does it hurt? What movements trigger symptoms?

• A precise physical exam: testing joints, tendons, nerve pathways, and motion patterns

• On-the-spot imaging when needed

• Ultrasound for tendon or nerve evaluation in some cases

• Determining whether symptoms come from a joint, tendon, or nerve — or a combination

This clarity guides a targeted, personalized plan that treats the actual cause rather than the symptom.

The Bottom Line: It’s Not Always “Just Arthritis”

Hand pain is common — but the diagnosis shouldn’t be generic.

When patients are told they “just have arthritis,” they often assume nothing can be done. In reality, most causes of hand pain are:

• highly treatable

• clearly diagnosable

• improved with the right targeted care

If your hand pain isn’t improving, or if your symptoms don’t match the classic arthritis pattern, an evaluation can help identify the true cause and get you back to comfortable, confident hand use.