Usually osteoarthritis of the finger joints or the base of the thumbStrong evidence
In a UK community study of adults aged 50 and over, painful arthritis at the base of the thumb affected 22.4% (27.4% of women and 16.7% of men), and painful arthritis of the finger joints with bony bumps (nodes) affected 15.5%. Both rose with age: at 80 and over, 32.0% of women and 19.8% of men had the painful finger joint type. In the US Framingham study, painful hand arthritis affected 15.9% of women and 8.2% of men aged 40 to 84.
The NHS says hand osteoarthritis often affects the base of the thumb, the joints nearest the fingertips and the middle finger joints; fingers can become stiff, painful and swollen, with bumps on the joints, and may bend slightly sideways. Arthritis UK calls the bumps Heberden's or Bouchard's nodes, says the hand you use most is often worse, and says arthritis of the big knuckles, where the fingers meet the hand, is less common. When the joints are inflamed, they can "look swollen and red and ... feel warm and tender to the touch". A less common form, erosive hand osteoarthritis, found in 2.8% of Dutch adults aged 55 and over, is the most painful: people with it had much higher odds of hand pain (an odds ratio of 3.6).
Sources 1, 2, 3, 4, 5
Bumps and X-ray changes are common, and don't predict painStrong evidence
In 3,906 Dutch adults aged 55 and over, X-rays showed hand arthritis in 67% of women and 54.8% of men, but it was only weakly linked with hand pain and with difficulty using the hands. "Many people with osteoarthritis of these joints have very little pain", the British Society for Surgery of the Hand (BSSH) says of the end finger joints, and the hands usually keep working well even when the joints become lumpy and bent. At the base of the thumb, X-ray changes show in about 25% of women over 55, "but many people with arthritis of this joint have no significant pain".
So the National Institute for Health and Care Excellence (NICE) diagnoses osteoarthritis without a scan from 45, when pain comes with activity and any morning stiffness lasts 30 minutes or less.
Sources 6, 7, 8, 9
Hand arthritis over time: it variesMixed evidence
Health-service pages are hopeful. Over time, the NHS says, the pain "may decrease and eventually disappear altogether, although the bumps and swelling can remain"; flares of pain, redness and swelling "frequently settle spontaneously over some weeks or months", the BSSH says; and thumb base symptoms "often stabilise over the long term".
Studies that followed people are less clear-cut. In UK adults aged 50 and over followed for 3 years, people with each type of painful hand arthritis had, on average, slightly more pain and difficulty at the end (0.5 to 1.5 points more on a 0 to 20 pain scale). In 289 people attending a Dutch clinic (average age 60, 83% women), half reported getting worse over 6 years, and X-ray changes didn't match how people felt; we read only that study's summary. So the course differs from person to person, and the bumps usually stay.
Sources 3, 7, 8, 1, 10
Grip weakens with age, and painful joints add to itStrong evidence
In 49,964 people in 12 British studies, grip strength fell from midlife, and by 80 about a quarter had a weak grip (23.0% of men and 26.6% of women). In 1,041 US adults aged 71 to 100, those with painful hand arthritis had a 10% weaker grip and more often found writing, handling small objects and carrying a 4.5 kg bundle hard.
Sources 11, 12
Trigger finger: a finger that catches or locksEmerging evidence
A finger or thumb clicks or locks bent, "often worse on waking in the morning", sometimes with a tender spot in the palm, and may need the other hand to straighten it, the BSSH says. It is more likely over 40 and with diabetes or rheumatoid arthritis, the NHS says. "It is not caused by osteoarthritis", and there is "little evidence that it is caused by work activities" (BSSH).
In US health records for 2015 to 2022, trigger finger affected 2.0% of people and 5.8% of people with diabetes; people with it averaged about 61 years old, and 63% were women, against 54% of people without it. The thumb (35%) and middle finger (34%) were affected most often, then the ring finger (26%). We read only that study's summary. In Korea's national records, about 4.8 women were newly diagnosed for every man, and new cases peaked at 50 to 59 in women and 60 to 69 in men. So it is commoner in women, but by how much depends on the records. A review found that trigger finger, carpal tunnel syndrome, Dupuytren's and a stiff hand are two to three times as common with diabetes, more so after 50.
Sources 13, 14, 15, 16, 17
Dupuytren's contracture: common in later life, and not usually painfulStrong evidence
Firm lumps and cords in the palm slowly pull one or more fingers, most often the ring and little fingers, in towards the palm. It "usually arises in middle age or later and is more common in men than women", is more common in Northern Europe and often runs in families, and "does not appear to be associated with manual work" (BSSH). The lumps can be tender at first, but it's not usually painful, the NHS says.
Across 23 Western studies, an estimated 12% of people had it at 55, 21% at 65 and 29% at 75. In 763 Dutch adults aged 50 to 89, 22.1% had signs of it but only 4.2% had a bent finger; men were affected more often than women (26.4% against 18.6%). It changes over "months and years rather than weeks", and it matters when the hand won't lie flat or daily tasks get hard.
Sources 18, 19, 20, 21
Carpal tunnel syndrome doesn't stop at midlifeStrong evidence
In UK general practice, new cases of carpal tunnel syndrome were most common in women at 45 to 54 but in men at 75 to 84, when women outnumbered men only about 1.5 to 1 (260.7 against 172.3 per 100,000 a year). In UK records from 1993 to 2013 it became more common, and the typical age of people with it rose, to 54 in women and 59 in men.
It causes an ache, tingling or numbness in the fingers and hand, usually worse at night, and later "a weak thumb or difficulty gripping", the NHS says. A nerve in the neck can cause hand symptoms "even when you don't feel pain in your neck", NHS inform says.
Sources 22, 23, 24, 25
Often more advanced by the time it's checkedEmerging evidence
In specialist referral clinics, older people with carpal tunnel syndrome more often had a weak thumb, a thin muscle at its base and worse nerve tests than younger people, though their symptoms sounded much the same. In 187 people aged 80 and over, the muscle had wasted in 26% of hands and the thumb was weak in 62%, and the authors thought people of that age seek care only once it has become severe. Left untreated, it "can cause permanent nerve damage and ongoing weakness", the BSSH says. These are clinic samples, not the whole population.
Pressure on the spinal cord in the neck can numb both hands, make buttons and handwriting harder and make you unsteady; in one series, 43% of people with it were first told they had carpal tunnel syndrome.
Sources 26, 27, 28, 29
Rheumatoid arthritis can start lateStrong evidence
In the UK, new rheumatoid arthritis is most common at 70 to 79 (12.2 women and 8.1 men per 10,000 a year), when women outnumber men only about 1.5 to 1, and that peak didn't change between 1994 and 2014. When it starts in later life it often has "a balanced gender distribution, acute onset, preferential involvement of larger joints", a review says, and some cases start like polymyalgia rheumatica, with stiff, aching shoulders.
It "usually affects the hands, feet and wrists", the NHS says, with joints that are swollen, warm and tender, and morning stiffness that "often lasts longer" than the 30 minutes typical of osteoarthritis. NICE asks GPs to refer suspected rheumatoid arthritis urgently when the small joints of the hands are affected, even if blood tests are normal.
Sources 30, 31, 32, 33, 34
Gout and calcium crystalsStrong evidence
In the UK, new gout was most common at 80 to 84 in both men and women, and the gap between the sexes narrowed with age. The NHS lists the hands and wrists among the joints it can affect, and a higher chance after the menopause and with water tablets (diuretics); repeated attacks can leave "hard lumps, called tophi, under your skin, usually on your ears, fingers or elbows".
In women, one review says, gout "is commonly superimposed on" arthritis of the end finger joints (a single review, so treat it as emerging), and Arthritis UK says gout in the hands "can look very much like osteoarthritis". Calcium crystal arthritis (pseudogout) affects men and women equally, and "it's rare for it to affect people under the age of 60"; it can affect the wrist, usually one joint at a time.
Sources 35, 36, 37, 4, 38
Infections: rare, but they need the same dayStrong evidence
A joint infection is rare: about 4 per 100,000 adults a year in western Sweden, rising to 14 per 100,000 at 80 and over, where crystals were also found more often in the joint fluid. A high temperature is common, "although not everyone has one", the NHS says.
Infections of the skin and of the tendon sheaths can follow a cut, splinter or bite, where "a relatively trivial injury may cause disproportionate amount of harm", an NHS hand clinic says. They can be more aggressive with diabetes, or with steroids and medicines for rheumatoid arthritis, and "some finger infections cause the finger to be held in a bent position". The NHS asks for help from NHS 111 the same day for any bite on the hand, and an urgent GP appointment or NHS 111 for skin that is painful, hot and swollen.
Sources 39, 40, 41, 42, 43
Other look-alikes
Fingers that turn white, then blue, then red in the cold can be Raynaud's. With no other condition behind it, it affects about 5% of people, in a pooled estimate from studies that defined it differently. The NHS asks you to see a GP if it first starts after 30 or comes with joint pain, rashes or muscle weakness. With diabetes, the hand joints can stiffen (limited joint mobility). A trapped nerve in the neck can cause pins and needles or burning in the hand, sometimes without neck pain.
Sources 44, 45, 17, 25
When a scan or test helpsStrong evidence
Hand osteoarthritis rarely needs an X-ray: NICE says not to use imaging routinely unless something doesn't fit, and Arthritis UK says blood tests are "sometimes helpful if there's any doubt" about the type of arthritis. Suspected rheumatoid arthritis needs blood tests and X-rays of the hands and feet, but they "should not delay referral", and when it starts in later life the blood tests are more often negative.
For gout, a urate blood test, repeated at least 2 weeks after a flare if it was low during one. For a hot joint, a sample of fluid from the joint is the only way to find crystals or rule out infection, and an ultrasound shows calcium crystals better than an X-ray. Nerve tests for carpal tunnel are "not always needed if the diagnosis is clear and symptoms are typical" (BSSH), though in older people they more often show severe damage. Both hands numb with unsteady walking needs a scan of the neck.
Sources 9, 4, 34, 31, 46, 47, 40, 28, 26, 29
How the other causes usually goEmerging evidence
"Some mild cases recover over a few weeks without treatment", the BSSH says of trigger finger, and the NHS says it can get better on its own. Dupuytren's changes over "months and years rather than weeks". An attack of gout "usually lasts 1 to 2 weeks if left untreated", and a calcium crystal attack lasts "from several days to two weeks". "In many cases, new pain or a flare-up of long-standing wrist, hand, finger or thumb problems should begin to settle within 6 weeks", NHS inform says. No one can promise a timescale.
Sources 13, 14, 18, 36, 38, 25
