Usually the base of the thumb, and more common with ageStrong evidence
In a UK community study, about 1 in 5 adults aged 50 and over (22.4%) had painful thumb base arthritis: 27.4% of women and 16.7% of men, rising to 39.8% of women over 80. It was the commonest painful hand arthritis. In US adults aged 71 to 100, painful hand arthritis went with a weaker grip and more trouble handling small objects.
X-ray changes are far more common than pain. In one sample of people with a broken wrist, thumb base changes showed in 91% of those over 80, and hand arthritis on X-ray was only weakly linked with hand pain in 3,906 Dutch adults. As the British Society for Surgery of the Hand (BSSH) puts it, "many people with arthritis of this joint have no significant pain".
Sources 1, 2, 3, 4, 5
The main wrist joint is arthritic less often, usually after an old injuryEmerging evidence
In 1,297 people aged 50 to 89 in a Japanese town, arthritis of the main wrist joint showed on X-ray in only 1.5% of wrists, the small joint next to the thumb base in 5.3%, and the joint between the forearm bones, on the little-finger side, in 21.2%. Wrist arthritis "most commonly develops secondary to prior trauma", such as an old break or a torn ligament, and the Royal Osteoporosis Society lists it among occasional long-term problems after a broken wrist. The evidence is thin: one population study and clinic series.
Sources 6, 7, 8, 9
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. It causes tingling, numbness or pain in the thumb, index and middle fingers, often at night, eased by shaking the hand.
Two look-alikes matter more with age. A nerve in the neck can cause wrist and hand symptoms "even when you don't feel pain in your neck", NHS inform says. Pressure on the spinal cord in the neck can numb both hands and make you unsteady, and it is often first labelled carpal tunnel.
Sources 10, 11, 12, 13
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 test results than younger people. In 187 people aged 80 and over, the muscle had wasted in 26% of hands, and the authors thought people seek care only once it is severe. In advanced cases the numbness can be constant and the pain "absent", the UK hand surgery pathway says, so a hand that doesn't hurt much isn't reassurance. These are clinic samples, not the whole population.
Sources 14, 15, 16
Calcium crystals (pseudogout): a common cause of a hot wrist after 60Strong evidence
An attack of calcium pyrophosphate crystal arthritis "affects men and women in equal numbers, but it's rare for it to affect people under the age of 60", Arthritis UK says. The knee is the commonest site, "followed by the wrist". In 3,170 UK adults with an average age of 66, calcium deposits showed at the wrist in 6.9%.
An attack brings "severe pain and stiffness in a joint, which comes on quickly and reaches its worst in just 12-24 hours", with swelling, redness and sometimes a fever, and can follow an illness or an operation. It can look exactly like gout or an infection; only crystals in fluid drawn from the joint confirm it. Calcium deposits on an X-ray are common without symptoms and need no treatment.
Sources 17, 18, 19, 20, 21
Gout and infectionStrong evidence
Gout can affect the wrist, though the big toe is commoner. In the UK, new gout is most common at 80 to 84 in both men and women, and the gap between the sexes narrows with age; water tablets (diuretics) and the menopause raise the risk.
A joint infection is rare (about 4 per 100,000 adults a year in western Sweden, 14 per 100,000 at 80 and over) but urgent. A high temperature is usual, "although not everyone has one", the NHS says: only about half of people over 80 with an infected joint had one, and some also had crystals in the joint.
Sources 22, 23, 24, 25
A fall onto the handStrong evidence
In the UK, broken wrists happen to about 37 in 10,000 women and 9 in 10,000 men aged 35 and over each year; in women the rate rises from the menopause, in men only later in life. In Germany, women aged 60 and over broke a wrist 3.8 times as often as men, rising to about 1,100 per 100,000 women a year at 85 and over.
A broken wrist from a fall at 50 or over is often the first fracture from thin bones: in one US study, 55% had another fracture within 10 years. The National Institute for Health and Care Excellence (NICE) counts it as a major osteoporotic fracture and offers a bone density (DXA) scan, and a fall injury that needed treatment qualifies for a full falls assessment. After the cast, stiffness can last months, and rarely the long thumb tendon ruptures, even after a break that hardly moved.
Sources 26, 27, 28, 29, 30, 31, 32, 9
Rheumatoid arthritis can start lateStrong evidence
In the UK, new rheumatoid arthritis is most common at 70 to 79, when women outnumber men only about 1.5 to 1, against 2.5 to 1 in the 40s. A third of people are over 65 when diagnosed. It "usually affects the hands, feet and wrists", with morning stiffness that lasts longer than 30 minutes, and some cases start over a few days. NICE asks for urgent referral when the small joints of the hands are affected, even if blood tests are normal.
Sources 33, 34, 35, 36
Tendons, lumps and rarer causesEmerging evidence
De Quervain's (a sore tendon on the thumb side) is more common in women and over 40, though data in older adults are lacking. Trigger finger is usually over 40. Ganglion cysts are "the commonest type of swelling in the hand and wrist", and palm-side ones are "seen in association with wrist arthritis in older individuals". A mucous cyst by the nail goes with arthritis of the end finger joint. Kienböck's disease is rare and mostly in working-age adults.
Sources 37, 38, 39, 40, 41
Walking sticks and frames: the evidence is indirectEmerging evidence
No study has measured how often walking sticks or frames cause wrist pain in older people. A Taiwanese study found carpal tunnel slightly more often after a broken leg or foot (12% higher), most clearly under 65, and couldn't show the walking aids were the cause. Crutches and frames put a lot of load through the hands, and in 25 people aged 65 and over, an angled frame handle reduced wrist bending and forearm effort in one session. A review notes that walking aids help balance, but their strength demands "can be excessive".
Sources 42, 43, 44, 45
When a scan or test helpsStrong evidence
After a fall, "You'll probably need an X-ray". Osteoarthritis needs no X-ray to diagnose from 45 with typical symptoms, NICE says. A hot, swollen joint needs fluid drawn from it, the only way to find crystals and rule out infection; an ultrasound shows 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); the UK pathway uses them when the diagnosis is unclear or before some surgery. Suspected rheumatoid arthritis needs blood tests, which shouldn't delay referral. A DXA scan follows a broken wrist from thin bones, and both hands numb with unsteadiness needs a scan of the neck.
Sources 28, 46, 20, 47, 16, 36, 30, 13
How it usually goesEmerging evidence
"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, and age-related changes can flare now and again. Thumb base arthritis symptoms "often stabilise over the long term". A pseudogout attack usually lasts "several days to two weeks". A broken wrist usually takes 6 to 12 weeks to recover, with stiffness that can last months. Untreated carpal tunnel can cause permanent nerve damage. No one can promise a timescale.
Sources 12, 5, 17, 28, 47
