Finger joint pain: arthritis, a jammed or sprained finger, trigger finger, swelling and what helps

The pattern is the best clueStrong evidence

The NHS says finger pain is often caused by bruising or injuring a finger, but there are lots of possible causes, and it sorts them by pattern: sudden, sharp pain, swelling and a popping or snapping sound at the injury points to a break; pain, swelling and bruising with a finger that is hard to move or grip with, to a sprain; a fingertip that won't straighten after catching it, to mallet finger; pain or tenderness in the palm at the base of a finger, with stiffness and clicking, to trigger finger; and an ache, numbness, tingling or weakness in the fingers, to carpal tunnel syndrome. It asks you not to diagnose the cause yourself, so the map above is a guide to the likely cause, not a diagnosis.

NHS inform adds that pins and needles, or sharp, hot or burning pain, in the hand or fingers can come from the neck, even when the neck doesn't hurt.

Sources 1, 2

Hand osteoarthritis: very common on X-rays, painful for fewer peopleStrong evidence

Without an injury, the commonest cause of finger joint pain from mid-life is osteoarthritis. In 3,906 Dutch adults aged 55 and over, 67% of women and 54.8% of men had it on X-ray in at least one hand joint: the end finger joints most often (47.3%), then the base of the thumb (35.8%), the middle joints (18.2%) and the knuckles (8.2%), usually in several groups of joints at once. Far fewer have painful hand osteoarthritis: 15.9% of women and 8.2% of men aged 40 to 84 in a US population study. A form that erodes the joints, erosive hand osteoarthritis, was found in 2.8% of adults aged 55 and over and in 10.2% of those with painful hand osteoarthritis, and it more than trebled the odds of hand pain.

The NHS describes stiffness, swelling, bumps on the finger joints, fingers that bend slightly sideways at the end joints, and sometimes painful cysts on the backs of the fingers. UK hand surgeons call the bumps on the end joints Heberden's nodes; the middle joints can get similar bumps. Arthritis UK says hand osteoarthritis mainly affects women and often starts around the time of the menopause.

Sources 3, 4, 5, 6, 7, 8

Inflammatory arthritis and gout: the cluesStrong evidence

Rheumatoid arthritis usually starts in the small joints of the hands and feet, often on both sides, with throbbing pain and stiffness that is worse in the morning and after resting, and usually lasts longer than the 30 minutes or so of osteoarthritis stiffness. NICE asks GPs to refer it urgently when the small joints of the hands or feet are affected, even if blood tests are normal. Psoriatic arthritis can swell a whole finger or toe (often 1 or 2 at a time) and pit or discolour the nails; it is often worse first thing, and the NHS says see a GP even if you don't have psoriasis. NICE asks for people with psoriasis to be checked for it every year.

Gout causes sudden, severe pain in a joint with hot, swollen, red skin. It is usually in the big toe, but the NHS says it can affect the hands and wrists, NICE describes its onset as rapid, often overnight, and Arthritis UK says it is commoner in cooler joints at the ends of the arms and legs, such as the fingers. The NHS lists drinking too much alcohol or eating a very large meal among the things that can trigger an attack. A related crystal arthritis (acute calcium pyrophosphate crystal arthritis) is rare under 60, usually affects one joint, most often the knee but also the wrist, and peaks within 12 to 24 hours.

Sources 9, 10, 11, 12, 13, 14, 15, 16, 17, 18

Injuries, trigger finger and the climber's fingerEmerging evidence

Finger sprains most often affect the middle joint, usually when a ball forces it backwards, and the ligament on its palm side (the volar plate) is the one most often hurt. UK hand surgeons say the swelling can last several months, but most people regain a full range of movement. The NHS says it can be hard to tell whether a finger is broken, dislocated or badly sprained, so you'll probably need an X-ray.

In trigger finger, a finger or thumb gets stuck bent and then clicks or pops straight, with pain in the finger or palm, often worse in the morning. The NHS says it is more likely over 40 and with diabetes or rheumatoid arthritis, and it can get better on its own. In climbers, injuries to the pulleys that hold the finger tendons are the commonest overuse injury, from the crimp grip. In 31 elite climbers with 25 years or more of climbing, bony spurs in the finger joints were commoner than in non-climbers but weren't linked with pain.

Sources 19, 20, 21, 22, 23, 24

Pregnancy, the menopause and finger jointsEmerging evidence

Some swelling of the fingers, ankles and feet is normal in pregnancy, often worse at the end of the day and later in pregnancy, and gradual swelling isn't usually harmful. A sudden increase in swelling of the face, hands or feet can be pre-eclampsia, which needs urgent help. Numb, tingling or aching fingers that wake you are usually carpal tunnel syndrome: 34% of 639 pregnant Dutch women reported it, more after 32 weeks and more with fluid retention and sleeping problems. The NHS says it often gets better by itself when pregnancy is the cause.

Muscle aches and joint pains are on the NHS's list of perimenopause and menopause symptoms, and Arthritis UK says hand osteoarthritis mainly affects women and often starts around the menopause; a review describes the evidence linking the two. Whether hormone replacement therapy (HRT) helps hand osteoarthritis is untested: the only trial we found was a feasibility study in 28 women, designed to see whether a full trial was possible, not whether HRT works.

Sources 25, 26, 27, 28, 29, 8, 30, 31

Other causes, each with its own clues

These are less common, but they need a different kind of help:

• Raynaud's: fingers that change colour in the cold or with stress, with pain, numbness or pins and needles, lasting minutes to hours.
• Chilblains: itchy, burning, red or purple patches on the fingers a few hours after being cold, usually gone in 2 to 3 weeks; warm the skin slowly, not on a radiator.
• Paronychia: skin around a nail that is sore, red, swollen and warm, which can be an infection.
• An infected tendon sheath: a red, swollen, throbbing finger held slightly bent. It is uncommon, sometimes follows a small cut or bite, and caught early it often settles with antibiotics.
• A fight bite: a cut over a knuckle from a punch can carry infection into the joint, with few symptoms for a few days.
• Dupuytren's contracture: lumps or cords in the palm that slowly pull a finger in, usually without pain.
• A ganglion: a smooth, fluid-filled lump near a joint, usually painless, which often goes on its own.

Sources 32, 33, 34, 35, 36, 37, 38, 39, 40

Tests and scansStrong evidence

NICE diagnoses osteoarthritis without a scan in people aged 45 or over with joint pain on activity and morning stiffness of 30 minutes or less, and keeps imaging for unusual features. X-rays and pain often don't match: the link between hand osteoarthritis on X-ray and hand pain was only modest in the Dutch population study.

After an injury it's different: you'll probably need an X-ray, and a sprain of the middle joint is X-rayed for a small flake of bone. Suspected rheumatoid arthritis needs blood tests and X-rays, which mustn't delay the referral; psoriatic arthritis may need blood tests, X-rays or scans; and gout is confirmed with a blood test for urate or fluid from the joint. A climber's pulley injury is checked with ultrasound first, then magnetic resonance imaging (MRI) if that is unclear. An infected tendon sheath is diagnosed mainly by examination, because blood tests are often normal early on.

Sources 41, 3, 21, 20, 10, 12, 16, 23, 36

How it usually goesEmerging evidence

NHS inform says new hand problems, or a flare of an old one, should begin to settle within 6 weeks. In hand osteoarthritis, X-ray changes progressed over 9 years in more than 9 in 10 people who had them, yet the NHS says the pain in the hands may decrease and even disappear over time, though the bumps and swelling can remain, and UK hand surgeons say painful flares in the end joints frequently settle on their own over weeks or months.

A sprained finger takes longer than people expect: the swelling can last months, and the finger can be sensitive to touch or cold for 1 or 2 years. A broken finger usually heals in 6 to 8 weeks, with full strength back by 3 to 4 months. No one can promise a timescale.

Sources 2, 4, 6, 7, 19, 20, 21

Hand osteoarthritis: exercise helps a little, and joint protection helped more peopleMixed evidence

NICE says offer therapeutic exercise to everyone with osteoarthritis, and explain that joint pain may rise at first but regular exercise will help. The European Alliance of Associations for Rheumatology (EULAR) lists education, assistive devices, exercise and splints as the main treatments without medicines for hand osteoarthritis.

The gains are modest. In a Cochrane review, exercise reduced hand pain by about half a point on a 10-point scale (5 trials, 381 people) and improved function a little, on low-quality evidence. In a Norwegian trial of 80 women, 3 months of home hand exercises improved the activities each woman cared most about by 1.4 points out of 10, with 16 responders against 2, and improved grip, pain and fatigue. In a UK trial of 257 people aged 50 and over, joint protection taught by occupational therapists in four group sessions made more people better at 6 months (33% against 21%), while hand exercises on their own didn't make a significant difference (28% against 25%).

Sources 41, 42, 43, 44, 45

Occupational therapists can lead the careEmerging evidence

In a Norwegian trial of 374 people with hand osteoarthritis, care led by occupational therapists did as well as care led by rheumatologists (28.6% against 28.4% responders at 6 months) and was good value. The NHS says an occupational therapist can advise on gadgets such as tap turners.

Sources 46, 47

Gels, tablets and injectionsEmerging evidence

NHS inform says an anti-inflammatory gel such as ibuprofen gel is the most effective painkiller for hand osteoarthritis; NICE suggests considering a gel like this for joints other than the knee, and EULAR makes it the first choice, with tablets for limited periods. The NHS adds capsaicin cream if gels haven't helped. Ask a pharmacist which suits you.

NICE says steroid injections give short-term relief, for 2 to 10 weeks; EULAR doesn't generally recommend them in hand osteoarthritis but says they can be considered for a painful finger joint. Hydroxychloroquine, an arthritis medicine, was no better than a placebo in 248 people. A 6-week course of prednisolone tablets eased finger pain more than a placebo in 92 people with clearly inflamed finger joints seen in rheumatology clinics: a specialist's option for a selected group, not self-care. NICE doesn't offer glucosamine or strong opioids for osteoarthritis.

Sources 48, 41, 42, 47, 49, 50

Splints: for the tasks that hurt, not all dayMixed evidence

NICE says don't routinely offer splints or supports for osteoarthritis unless a joint is unstable, exercise alone isn't working and the device is likely to help. NHS inform says a splint may help during repetitive activities, not all the time, often for just a few weeks. For painful end-joint arthritis, two small series of 25 and 30 people without a comparison group reported less pain with small finger splints over 1 to 6 months: too little to recommend them widely, but reasonable to try for the tasks that hurt.

Sources 41, 48, 51, 52

After a sprain: early movement within comfortEmerging evidence

UK hand surgeons support a sprained middle joint for 2 to 3 weeks, usually by strapping it to the next finger or with a small splint, and start hook and full-fist exercises early, 10 times, 4 to 6 times a day, within comfort, because early movement helps prevent lasting stiffness. Losing some straightening and, less often, a loose joint are the recognised problems. Contact the clinic if movement is getting worse 6 weeks after the injury. Our jammed finger guide gives the full plan.

Sources 20, 19

Inflammatory arthritis and gout need medical treatment firstStrong evidence

Rheumatoid and psoriatic arthritis are treated with disease-modifying medicines from a specialist team; exercise goes alongside them, never instead. A gout attack is treated early with an anti-inflammatory, colchicine or a short course of steroid tablets, and the NHS says medicine taken as soon as an attack starts should begin to work within 2 days; frequent attacks need a medicine that lowers urate. Our exercise pages for rheumatoid arthritis and gout cover the exercise side.

Sources 10, 12, 16, 15, 17

Knuckle cracking hasn't been linked with arthritisEmerging evidence

In 215 people aged 50 to 89, hand osteoarthritis was no more common in people who habitually cracked their knuckles (18.1% against 21.5%), and an older study of 300 people found no more hand arthritis either, though it linked habitual cracking with hand swelling and a weaker grip. A later study of 40 adults, examined by doctors who didn't know who cracked their knuckles, found no swelling or weakness. These are observational studies, not trials.

Sources 53, 54, 55

The NHS's first steps (written steps)

The NHS and NHS inform give the same first steps for most finger pain. They aren't tested treatments, but they are consistent health-service advice.

• 1. Rest your finger when you can, and stop or cut down what brings it on, such as typing, vibrating tools at work or playing an instrument.
• 2. Put an ice pack (or a bag of frozen peas) in a towel on the finger for up to 20 minutes every 2 to 3 hours. Don't use heat packs or hot baths for the first 2 to 3 days after an injury.
• 3. Use paracetamol or ibuprofen gel, or ibuprofen tablets if needed; a pharmacist can advise, including on splints, and flexible rubber splints let you keep using the finger.
• 4. Take off any jewellery on the painful finger.
• 5. Strap the painful finger to the one next to it: a small piece of cotton wool or gauze between the 2 fingers, and tape to strap them loosely together.
• 6. Use gadgets for jobs such as opening jars or chopping vegetables, and don't lift heavy things or grip anything too tightly.
• 7. Don't stop using the finger completely: in the first 48 hours, move the hand gently for 10 to 20 seconds every hour while you're awake (NHS inform), and after a few days, start gentle hand and finger exercises (the NHS).

Sources 1, 2

NHS inform's finger exercises (written steps)

The 3D figure moves all four fingers together, so these come as written steps. The names are NHS inform's hand exercise videos; the descriptions are our plain wording. Start with 2 or 3 repetitions at a time, every hour if you can; add 1 or 2 every few days; then work in sets of 8, up to 2 sets of 15; keep pain at 5 out of 10 or less and no worse the next morning (NHS inform).

• 1. Full finger bend: make a gentle fist, then straighten the fingers fully (the full fist in the tendon glides).
• 2. Hook finger bend: keep the big knuckles straight and bend the middle and end joints into a hook.
• 3. Duck finger bend: bend only at the big knuckles, keeping the fingers straight, like a tabletop.
• 4. Flat fist: bend the big and middle joints with the end joints straight, so the fingertips touch the base of the palm.
• 5. Spreading and closing the fingers: spread them wide, then bring them together.
• 6. Thumb and finger touch: touch the thumb to each fingertip in turn, making an O.
• 7. Finger walking: sit with your forearms and hands flat on a table, palms down. Move the thumb out to the side, then lift the index finger and put it down as close to the thumb as is comfortable; do the same with the middle, ring and little fingers in turn, then lift the hand and start again. The move page's dose, from the NHS SARAH leaflet: start with 5 repetitions, holding each position for 5 seconds, then build to 10 repetitions, then 10-second holds, daily.
• 8. After a jammed finger has been checked, single-joint bends: rest your forearm on a table, palm up. Hold the finger just below its middle joint with your other hand, so the big knuckle stays straight, and bend and straighten the middle joint; then hold the middle part of the finger and bend and straighten the end joint. The move page's dose, from NHS hand therapy leaflets: 5 bends of each joint, holding each for 5 seconds, every 1 to 2 hours.
• 9. Hand wave, wrist bend, and palm up and down: gentle wrist and forearm movements, as in the wrist and forearm flow.

Sources 57, 56

Buddy strapping (written steps)

For a sprained finger once it has been checked, or a sore finger the NHS suggests strapping. Our jammed finger guide gives buddy strapping step by step; in short:

• 1. Take any rings off that hand first.
• 2. Put a small piece of cotton wool or gauze between the sore finger and its neighbour (the NHS).
• 3. Tape the two fingers together loosely, with the tape between the joint creases so the joints can still bend (our jammed finger guide).
• 4. Check the fingertip's colour and feeling: if it changes colour, goes cold or numb, or you get new pins and needles, it's too tight, so loosen it.
• 5. Change the tape and padding when they get wet, and check the skin between the fingers every day.
• 6. After a sprain of the middle joint, UK hand surgeons say strapping or a small splint usually stays on for 2 to 3 weeks, depending on the injury.

Sources 1, 20

A ring on a swelling finger (written steps)

No NHS page covers a stuck ring, so these steps are our advice. The reason: as a finger swells, a tight ring can cut off its blood supply. The NHS says to take jewellery off a painful finger and rings off an injured hand, and an NHS hand trauma service says to take rings off after a hand injury.

• 1. Take rings off as soon as a finger is injured or starts to swell, before it gets tight.
• 2. If a ring won't come off, don't keep tugging at it. Raise your hand and go to a minor injuries unit, an urgent treatment centre or A&E, where it can be cut off.
• 3. Go to A&E straight away if the finger beyond the ring turns pale, blue or cold, or goes numb.
• 4. In pregnancy, or with swelling from arthritis, take rings off while they still come off easily.

Sources 1, 21, 59

Protecting finger joints (written steps)

Joint protection taught by occupational therapists made more people with hand osteoarthritis better in a UK trial, and the NHS suggests gadgets and a splint for the tasks that hurt. The exact list below is our suggestion, built on those sources.

• 1. Bigger grips: foam tubing on handles, thicker pens, larger cutlery and padded tool handles.
• 2. Two hands, and the load close to your body, rather than one hand pinching.
• 3. Gadgets: jar openers, tap turners, a key turner and an electric tin opener.
• 4. Pace the heavy hand jobs: spread them through the day and the week.
• 5. A splint for the tasks that hurt, rather than all day; a pharmacist, physiotherapist or occupational therapist can advise.

Sources 45, 47, 1, 48

Pregnancy (written steps)

These come from the NHS's carpal tunnel and pregnancy swelling pages.

• 1. For tingling or numb fingers, wear a wrist splint at night; the NHS says you may need it for up to 6 weeks before it helps.
• 2. Cut down on things that make you grip hard or bend your wrist a lot.
• 3. For swelling, avoid standing for long, rest with your feet up when you can, and take regular walks.
• 4. Take rings off before they get tight (our suggestion).
• 5. A sudden increase in swelling of the face, hands or feet, a very bad headache or problems with your vision needs your midwife, GP or labour ward straight away.

Sources 28, 25, 26

Gripping, typing, tools, climbing and sport come back (written steps)

No trial has tested how to bring these back after finger pain. These steps are our suggestion unless a source is named.

• 1. Daily tasks first, with the joint protection steps above.
• 2. Typing, mice and phones: shorter spells, breaks every 30 to 60 minutes and a change of grip; the NHS says cut down activities that bring finger pain on, such as typing. Our typing guide covers the set-up.
• 3. The gym: carries and curls with thick handles come back in stage 3, after the hand is comfortable with the stage 2 work.
• 4. Climbing: easy, open-hand holds first, and warm up properly; crimping comes back last. After a pulley injury, our finger pulley guide's staged return applies.
• 5. Ball and contact sport after an injury: when the hand clinic says, often with the finger taped to its neighbour (our finger injury guides). NHS inform says avoid sport or heavy lifting until there is less discomfort and good movement, and warm up fully first.

Sources 2, 1, 23