The knuckles on the top of the hand

Knuckle pain and stiff and sore fingers are most often the result of arthritis of the hands and fingers. The most common form of arthritis is osteoarthritis, which occurs from wear and tear to joints over time with repetitive use and older age, but other forms of arthritis like rheumatoid arthritis and psoriatic arthritis are autoimmune diseases that often have a genetic link and run in families.

Treatments for easing knuckle pain from arthritis range from more conservative options like heat and cold therapy, exercises and stretches, and over-the-counter (OTC) medications, to more involved options like physical and occupational therapy and cortisone injections when symptoms interfere with everyday activities.

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What Causes Knuckle Pain?

Each hand is composed of 27 different bones. These include the eight carpal bones at the bottom of the hand closest to the wrist, the five long metacarpal bones that make up the palm of the hand and connect to the carpal bones, and the remaining 14 phalange bones that make up the fingers.

The knuckles form at the joining of the metacarpal bones of the hand and the proximal phalangeal bones, or the first set of the three phalangeal bones that make up each finger. This area is referred to as the metacarpophalangeal (MCP) joint.

The surfaces of the metacarpal and phalangeal bones that form the knuckles, or MCP joints, are lined with protective cartilage that provides cushioning and prevents friction between bones with movement. In arthritis, the cartilage breaks down over time, causing pain and increased difficulty moving the joints. In severe cases, the cartilage wears down so much that bone rubs directly against bone, causing increased pain, inflammation, and joint damage.

While arthritis, including osteoarthritis (OA), rheumatoid arthritis (RA), or psoriatic arthritis (PsA), is the most common cause of knuckle pain, other causes include hand and finger injury, scleroderma (which causes hardening and tightening of the skin), and gout.

Knuckle pads, also called Garrod’s nodes, are commonly misdiagnosed as arthritis in knuckles. Knuckle pads are fatty pads found under the skin overlying the proximal interphalangeal joints of the fingers, but rarely exist at the MCP joints of the knuckles. They often affect both hands and typically do not cause pain.

Arthritis Hand Pain

In the United States, approximately 40% of adults will develop symptoms of arthritis in at least one hand by the age of 85. Symptoms are almost twice as likely to affect women, and are more likely to affect Caucasians than other ethnic groups.

Symptoms of Arthritis in Hands

Common symptoms of knuckle arthritis include:

• Pain: Joint pain is the most common symptom of knuckle arthritis that results from the breakdown of cartilage in the MCP joint. This lack of protective cushioning and shock absorption from cartilage loss causes the ends of the finger bones to grind against each other with increased friction.
• Tenderness: Increased pain and inflammation that result from knuckle arthritis can cause tenderness around the knuckles and in the fingers.
• Stiffness: Cartilage helps provide cushioning within joints and allows bones to glide smoothly over one another. When cartilage breaks down with knuckle arthritis, the knuckles and finger joints can stiffen up, making hand and finger movements difficult.
• Decreased range of motion: Arthritis of the knuckles can cause decreased range of motion in your finger joints, which can limit your ability to pinch, grip, and grasp objects.
• Swelling: Knuckle arthritis may cause swelling in your knuckles from inflammation as a result of increased friction between the finger bones from cartilage degradation. Swelling within the knuckles can also result from inflammatory processes that attack the joints that occur with autoimmune forms of arthritis, such as RA and PsA.
• Weakness: Arthritis of the knuckles can cause weakness in the muscles of the hands and fingers, especially if the muscles are not used often or if moving the joints is painful.

Describing the Pain

It may be difficult to exactly pinpoint the type of knuckle pain you are experiencing from arthritis. Some words that may be useful in explaining your symptoms to your doctor include:

• Deep, aching pain inside the joints of your knuckles
• Increased pressure at rest when you aren’t moving your fingers
• Stiffness that prevents you from moving your fingers easily

Knuckle Pain Relief

Treatment options for arthritis pain in knuckles include a variety of methods. Home remedies for knuckle arthritis may be able to help alleviate your symptoms, including:

• Rest: Resting the finger joints by limiting hand use and avoiding activities like repetitive gripping, grasping, and pinching can help ease knuckle pain and inflammation.
• Immobilization: Wearing a hand splint to immobilize the finger joints can reduce pain and inflammation in the knuckles, especially if they are aggravated by activity.
• Heat: Heat therapy is best used for chronic knuckle arthritis to help loosen and relax tight muscles and stiff joints.
• Ice: Applying ice to the fingers can help relieve pain and inflammation within the knuckle joints, especially if swelling is present.
• Medication: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage symptoms and reduce pain.
• Topical pain relievers: OTC creams and ointments, especially those containing capsaicin, an extract derived from chili peppers, can be applied topically to the hands and fingers to help relieve pain by decreasing the intensity of pain signals sent along nerve pathways.
• Paraffin: Warm paraffin wax application to the hands and fingers can help decrease knuckle pain and joint stiffness.
• Exercises: Stretches and exercises for your hands and fingers can help ease pain, improve range of motion and joint mobility, and increase the strength of the muscles of your hands and fingers.

When arthritis symptoms in your hands and knuckle pain continue to persist even after trying these home remedies, your doctor may prescribe treatments to improve your symptoms:

• Prescription medications: Higher-strength medication may be prescribed to reduce pain and inflammation, including disease-modifying anti-rheumatic drugs (DMARDs) if you have RA.
• Rehabilitation: Your doctor may refer you to physical or occupational therapy to improve the mobility of your finger joints, increase the strength and flexibility of your hand muscles, and apply therapeutic modalities to alleviate pain, stiffness, and swelling.
• Corticosteroid injections: Your doctor may suggest administering a corticosteroid injection into the joints of your knuckles to help reduce inflammation and pain if other methods are not effective.

Rheumatoid Arthritis Doctor Discussion Guide

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Associated Conditions

Arthritis is a degenerative condition that tends to get worse over time. If treatment is not started early, pain and disability can increase as the knuckle joints become more degenerated. As inflammation of the joints increases with further joint degeneration, the appearance of the knuckles and fingers can become deformed.

Common complications of arthritis in your knuckles that can develop with condition progression include:

• Boutonniere deformity: A joint deformity where the middle joint of the finger becomes stuck in a bent position while the MCP joint of the knuckle becomes stuck in a hyperextended position
• Ulnar deviation: A joint deformity where the fingers become angled away from the thumb as a result of chronic joint degradation at the MCP joint of the knuckles, resulting in gradual dislocation of the fingers.

Summary

Arthritis in your knuckles can cause debilitating symptoms like pain that make everyday tasks more difficult to complete. A wide variety of options are available to help you reduce these symptoms and improve the mobility and range of motion of your knuckles and fingers. If home remedies like exercise and rest are not effective, you should speak with your doctor, who can prescribe other treatments to help with your symptoms.

A Word From Verywell

If you have knuckle pain, stiffness, or difficulty fully moving your fingers, you may be experiencing symptoms of arthritis in your hands. Home remedies can be helpful for alleviating your symptoms, but if you continue to suffer from significant pain and disability, make sure to talk with your doctor to determine a possible diagnosis and discuss treatment options to better manage your symptoms.

Frequently Asked Questions

• How do you know if you have arthritis? A diagnosis of arthritis can be made based on symptoms and imaging tests. Symptoms of arthritis include joint pain, stiffness, and decreased range of motion affecting your ability to move your joints. An X-ray may show cartilage degeneration and joint space narrowing within affected joints.
• What home remedies relieve knuckle pain? Home remedies for relieving knuckle pain from arthritis include exercises and stretching, heat or ice, over-the-counter medications like NSAIDs and capsaicin cream, and rest for your fingers. If these home remedies have very little or no effect on knuckle pain, a doctor can help you find treatment.
• Does knuckle cracking cause arthritis? Knuckle cracking does not cause or increase your risk of arthritis, but it may lead to decreased grip strength over time.

Why do my hands swell when I run?

The exact reason for why the hands can swell while running or walking is currently unknown, but there are some theories.

One possible explanation is metabolic changes; during exercise, blood is directed away from the hands, causing them to become colder. This makes blood vessels in the hands open wide, which causes hand swelling. Because of this, hand swelling is even more likely when exercising in cold weather.

What are the upper knuckles called?

The first and largest knuckle is the junction between the hand and the fingers - the metacarpophalangeal joint (MCP). This joint commonly is injured in closed-fist activities and is commonly known as a boxer's fracture. The next knuckle out toward the fingernail is the proximal inter-phalangeal joint (PIP).

What is the top of your hand called?

The front, or palm-side, of the hand is referred to as the palmar side. The back of the hand is called the dorsal side. There are 27 bones within the wrist and hand. The wrist itself contains eight small bones, called carpals.

What is the medical term for knuckles on your hands?

Metacarpophalangeal Joint (MCP): The MP joint is where the hand bone meets the finger bone, referred to as the “knuckle.” These joints are very important, allowing us to bend/flex and spread our fingers.

What is the knuckle area of the hand?

Each finger contains 3 joints, more commonly known as knuckles. The thumb has two knuckle joints. The largest joint of each finger lies between the finger and the hand. This first joint at the base of the finger is called the metacarpophalangeal joint (MCP).