Osteoarthritis of the hands

Rhizarthrosis (trapeziometacarpal osteoarthritis) results in spontaneous mechanical pain at the base of the thumb, at the anatomical snuff-box and outer part of the wrist, with a kind of burning or shooting pain accompanied by difficulty in gripping or pinching motions. Night pain may occur during inflammatory episodes.

On examination the pain is caused by the pressurisation of the column of the thumb with circumduction movements of the first metacarpal.

Pitfalls to avoid

• A scaphoid fracture
• Abarticular pathology: De Quervain tenosynovitis, synovial cyst, etc.
• Chondrocalcinosis

Digital osteoarthritis is characterised by pain in the fingers, more pronounced in the dominant side, accentuated by carrying heavy loads and discomfort in daily activities, sometimes at night with flexion and extension stiffness in the morning.

On examination, one can find unsightly multiple and bilateral deformity of the fingers evolving in painful flare-ups: Heberden nodes of the distal interphalangeal joints and less frequently, Bouchard's nodes of the proximal interphalangeal joints.

Pitfalls to avoid

• Inflammatory arthritis: psoriatic arthritis, rheumatoid arthritis, chondrocalcinosis, hemochromatosis, etc.