Osteoathritis of the hand and wrist

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Patient Information

A progressive degenerative disorder of the small joints of the hand.
Patients typically complain of pain and deformity.
Examination may reveal heberdens nodes and mucous cysts (DIPJ OA), or Bouchards nodes(PIPJ OA) and joint contractures.

Blood tests and radiography are not usually indicated as part of a primary care assessment of suspected small joint osteoarthritis and are not required prior to commencing treatment or for referral.

Utilise a shared decision-making approach.
NICE core treatments are safe, low cost and widely accepted. Provide information and advice through leaflets and alternative sources.
Initial treatment includes.
Exercise.
Paracetamol (regular better than ‘as required’) and NSAIDs (standard NSAID precautions).
When symptoms affect activities of daily life refer to physiotherapy or Occupational therapy for joint protection training, protective splints, and assistive device.
Steroid injections have limited efficacy but may provide temporary relief.
Surgical interventions include fusion, joint replacement and denervation.
Referral indications: Diagnostic uncertainty, Referral for physical therapy, Referral for intra-articular steroid injection, A fit patient willing to undergo surgery with pain/stiffness/loss of function significantly impacting quality of life and refractory to non-surgical treatment.