What are the treatment options for hand joint pain?

Treatment Options for Hand Joint Pain

For hand joint pain presumed to be osteoarthritis, begin with a custom-made thumb splint (worn for at least 3 months), topical NSAIDs, and a structured exercise program combining range of motion and strengthening exercises, as this combination addresses pain relief, function preservation, and long-term joint protection. 1, 2

Initial Treatment Algorithm

First-Line Therapy (Start All Three Simultaneously)

• Topical NSAIDs are the preferred initial pharmacological treatment due to superior safety compared to systemic agents, particularly for mild to moderate pain affecting few joints 1, 2

• Custom-made thumb base splint (neoprene or rigid orthosis) must be worn consistently for at least 3 months to achieve optimal symptom relief—shorter durations show minimal benefit 2

• Exercise regimen incorporating both range of motion and strengthening exercises should be prescribed to all patients to improve joint mobility, muscle strength, and thumb base stability 1, 2

• Joint protection education teaching avoidance of adverse mechanical factors is essential for all patients 1, 2

• Heat therapy (paraffin wax or hot packs) applied before exercises provides symptomatic relief with 77% recommendation strength, significantly stronger than ultrasound at 25% 1, 2

Second-Line Therapy (If Inadequate Response After 4-6 Weeks)

• Acetaminophen up to 4g daily is the oral analgesic of first choice due to efficacy and safety profile, and should be the preferred long-term oral analgesic if successful 1, 2

• Topical capsaicin may be added as an alternative topical agent, applied as a thin film 3-4 times daily to affected areas 2, 3

Third-Line Therapy (If Still Inadequate After 8-12 Weeks)

• Oral NSAIDs at the lowest effective dose for the shortest duration should be used only when topical treatments and acetaminophen fail 1, 2

• In patients ≥75 years, topical NSAIDs are strongly preferred over oral NSAIDs due to safety concerns regarding gastrointestinal, cardiovascular, and renal adverse effects 2

• For patients with increased gastrointestinal risk, combine non-selective NSAIDs with gastroprotective agents or use selective COX-2 inhibitors 1

• Intra-articular corticosteroid injection is effective specifically for painful flares of the trapeziometacarpal (thumb base) joint 1, 2

Surgical Consideration (After Conservative Failure)

• Surgical options (interposition arthroplasty, osteotomy, or arthrodesis) should be considered for severe thumb base OA with marked pain and disability when all conservative treatments have failed 1, 2

Critical Caveats and Common Pitfalls

• Splinting compliance is crucial: The splint must be worn for at least 3 months continuously; shorter periods yield no significant benefit 2

• Exercise specificity matters: Exercise regimens for the first carpometacarpal (thumb base) joint differ substantially from those for interphalangeal joints and must be tailored accordingly 2

• Avoid these interventions: Intra-articular therapies (except corticosteroids for acute flares), opioid analgesics, conventional or biological disease-modifying antirheumatic drugs, and glucosamine/chondroitin (effect sizes are small with unestablished clinical relevance) 1, 2

• Long-term oral NSAID use should be avoided due to cumulative gastrointestinal, cardiovascular, and renal toxicity 2

• Ultrasound therapy has weak evidence with only 25% recommendation strength and 0% strong recommendation rate, making it a poor choice 1

Special Populations

• For erosive hand OA: The same conservative approach applies, though pharmacological options remain largely symptomatic with no disease-modifying agents currently effective 4

• For patients with multiple joint involvement: Orthoses for joints beyond the first carpometacarpal joint are conditionally recommended as disease progresses 2