What Are The Causes Of Finger Joint Pain?

Overview

Finger joint pain is an issue that affects many individuals across the globe. There are many possible causes of finger joint pain, ranging from infections to arthritis. This article will aim to provide a detailed exploration of some of the possible causes of finger joint pain and look at how such pain is investigated and managed by healthcare professionals.

Anatomy of the hand and fingers

Before exploring the causes of joint pain in the hand, it is important to know the names and locations of all of the joints in the hand. There are three main types of joints present in the human finger. 

• Carpometacarpal joints are often informally known as the “knuckles” of the hand. These joints are located at the base of the fingers and join the fingers to the palm and the rest of the hand.¹
• Proximal interphalangeal joints (PIPs) are the joints often found in the middle of the finger, and they allow individuals to be able to grip objects such as door handles and cups¹
• Distal interphalangeal joints (DIPs) are the joints typically located near the tips of the fingers. Like the proximal interphalangeal joints, these allow the tops of the fingers to bend, which enables us to hold various objects¹

It is important to be aware of the different types of finger joints as different medical conditions tend to affect a different range of finger joints. 

Possible causes of finger joint pain

There are several causes of finger joint pain; some of the most common are outlined below.

Osteoarthritis

Located within the finger joint is a layer of tissue known as cartilage. This layer allows joints to glide past each other seamlessly and cushions the joint space. 

Osteoarthritis was once thought to be a degenerative condition that ‘wears down’ cartilage; however, more recent research suggests that inflammation in the subchondral bone can lead to cartilage damage.⁷ It is the most common type of arthritis and tends to affect the hands, hips and knees. 

There are several risk factors for osteoarthritis:²

• Joint injury
• Joint overuse
• Gender (women are more likely to be affected)
• Obesity
• Anatomical Factors
• Age (osteoarthritis is more common in older individuals)

Common signs and symptoms of osteoarthritis include:

• Joint pain and stiffness that tends to worsen with activity and at the end of the day
• Bony swellings in the DIP or PIP joints
• Reduced range of motion
• Squaring of the base of the thumb in the carpometacarpal joint
• Weak grip

It is agreed that a diagnosis can be made if the individual is over 45, has the typical pain associated with osteoarthritis and has no to minimal morning stiffness.² In other cases, further investigation would have to be carried out. 

A common investigation used to investigate possible cases of osteoarthritis is a hand X-ray. On the X-ray, some key changes may be noted. These include a clear narrowing of the finger joint space, increased density of bone along the bone line, fluid-filled holes in the bone and bony growths surrounding the joint.² 

Management of osteoarthritis includes pain relief medication, joint injections (more commonly used for hips and knees) and physiotherapy.²

Rheumatoid arthritis

Another form of arthritis that can affect the finger joints is rheumatoid arthritis. This is an inflammatory condition which results in joint pain, joint stiffness, and joint swelling.³

As this form of arthritis is due to inflammation, the joint stiffness usually occurs in the morning and tends to last 30 minutes or more. The joint pain also tends to improve with movement, unlike osteoarthritis.³

Rheumatoid arthritis tends to affect the metacarpolphalangeal (MCP) and PIP joints in the hand.³ In patients with advanced disease, some physical changes in the hand can be noted. These include:

• A Z-shaped thumb
• Swan neck deformity (hyperextended PIP and flexed DIP joint)
• Boutonniere deformity (hyperextended DIP and flexed PIP joint)
• Ulnar deviation of the fingers at the MCP joints 

During the initial assessment of suspected rheumatoid arthritis, several investigations have to be carried out. These include blood tests for markers such as rheumatoid factor and antibodies called Anti-CCP.³ Additional markers that can be looked at include inflammatory markers such as erythrocyte sedimentation rate and c-reactive protein. Further investigations include X-rays of the hand to look for the typical rheumatoid arthritis changes. 

Changes seen on the X-ray include:

• Erosions of the bone
• Joint destruction and deformity

Management of rheumatoid arthritis is vastly different from osteoarthritis and involves several types of medications. This includes pain relief, short-term steroids, and the use of disease-modifying anti-rheumatic drugs.³ Specialist drugs known as biologics may be used for more advanced diseases. These are drugs which interact with the immune system.³

Psoriatic arthritis

Psoriatic arthritis is another cause of painful finger joints. Similar to rheumatoid arthritis, it is an inflammatory arthritis and is associated with psoriasis.⁴ Psoriatic arthritis can occur without any skin changes. 

Unlike rheumatoid arthritis, psoriatic arthritis tends to affect the distal interphalangeal joints and not the proximal interphalangeal joints.⁴

Other physical signs seen in psoriatic arthritis:

• Psoriasis plaques on the skin
• Nail pitting
• Onycholysis (separation of the nail from the nail bed)
• Dactylitis (inflammation of the entire finger)

An X-ray can also be used to investigate suspected cases of psoriatic arthritis. A classic X-ray finding is known as ‘pencil in a cup’. Erosion occurs in one end of the joint, and the bone appears pointed in the joint space.⁴

The treatment for psoriatic arthritis needs to be decided by a specialist team and may involve input from skin and joint specialists. The medications used are similar to rheumatoid arthritis and include steroids, anti-inflammatory drugs, disease-modifying anti-rheumatic drugs amongst others.⁴

Ganglion cysts

This is a lump that often occurs over several months and tends to occur on the back and front of the wrist.⁵ These are not usually cancerous. As a result, the management of ganglion cysts consists of techniques such as surgery and needle aspiration, which can be used to relieve the symptoms.⁵

Bone tumours

Bone tumours are relatively rare but are an important differential to be aware of. The main feature of a bone tumour is severe pain that is present during the night, and a mass may also be noted in the affected areas. Risk factors for bone tumours include genetic predisposition, previous exposure to radiation and benign bone conditions such as Paget’s disease.⁶

Investigations for bone tumours include X-rays, CT, and MRI scans. Management often consists of surgical removal of the tumour if the tumour is malignant. Radiotherapy and chemotherapy are often used as adjunctive treatments.⁶  

Summary

There are several joints located in the fingers and thumbs of the human body. Different causes can lead to pain and other troublesome symptoms which can affect different joints in turn. Causes can include osteoarthritis, ganglions, and tumours. If an individual suspects that they have any of the conditions listed in this article, they should contact a medical professional. This will allow the condition to be diagnosed and enable them to have a treatment plan that alleviates their pain and discomfort. 

FAQs

Can infections cause finger joint pain?

If the infection develops and infects the joint, a condition known as septic arthritis can occur. Here the joint is inflamed, hot, and red with a distinct fluid-filled appearance. However, this tends to mostly be located on the knee joint and does not affect fingers as often.

Can arthritis be cured?

Unfortunately, no cure can get rid of the arthritis completely. The medications that are currently recommended are to control the arthritis and relieve the pain that the patients feel. Arthritis is, unfortunately, a long-term condition and can get worse over time. 

When should I see a doctor about my finger joint pain?

It is recommended that individuals seek medical advice whenever they are concerned about the development of new symptoms. In the case of finger joint pain, new onset pain, which has an impact on the quality of life, should be discussed with the doctor. 

Are there any causes of finger joint pain that this article has not covered?

A very common cause of hand or finger pain is injury, so it is good to let a medical professional know when and how the finger was injured. This enables the medical professional to be able to provide the best possible care.

Is it guaranteed that an individual may develop arthritis if their family does?

There is a genetic component to many arthritis cases, but it is by no means guaranteed that an individual will develop arthritis just because a family member has the same condition.