Osteoarthritis of the hip and hand: the joints that get less attention

Osteoarthritis is usually discussed as a knee problem. Hip and hand involvement are both common, both have their own presentations, and both respond to different approaches.

Hip osteoarthritis, and why it is misdiagnosed

The classic presentation is groin pain — not lateral hip pain, which is more often trochanteric bursitis or gluteal tendinopathy. Pain frequently radiates to the front of the thigh and sometimes to the knee, and occasionally the knee is the only site of complaint, which is why hip disease is regularly investigated as a knee problem.

It can also present as buttock or lower back pain, which is why it is frequently confused with lumbar spine disease. The two coexist often enough — sometimes called hip-spine syndrome — that distinguishing them requires care.

The practical distinguishing features:

• Restricted internal rotation is the earliest and most reliable sign. Lying flat with the hip and knee bent to 90 degrees, rotating the lower leg outward should bring the hip into internal rotation comfortably. Early loss of this range, with pain, is characteristic.
• Difficulty with socks, shoes and toenails — a very common first functional complaint.
• Groin pain on weight-bearing, worse after activity, with stiffness after sitting that eases within about thirty minutes.
• Pain does not change with spinal position, unlike stenosis.

Managing hip osteoarthritis

The evidence supports exercise as first-line, as at the knee, though the trial literature is smaller.

Hip abductor strengthening is central — the gluteus medius controls pelvic stability during single-leg stance, and weakness produces the characteristic waddling gait that increases load through the joint. Side-lying leg raises, standing abduction against a band, and single-leg stance work.

Hip extension and rotation work, within comfort. Aquatic exercise is particularly well tolerated where weight-bearing is painful, and has reasonable evidence for hip osteoarthritis.

A walking stick used in the opposite hand reduces hip joint load by a meaningful amount — this is basic lever mechanics and it is frequently done wrong, with the stick held on the painful side where it achieves considerably less.

Total hip replacement is, when eventually needed, one of the most successful operations in medicine, with high satisfaction rates and reliable pain relief. Outcomes are better in people who go into surgery stronger, which is the argument for prehabilitation rather than waiting passively.

Hand osteoarthritis

Very common, particularly in women after menopause, and with a strong hereditary component. It has a characteristic distribution: the distal interphalangeal joints, producing Heberden's nodes; the proximal interphalangeal joints, producing Bouchard's nodes; and the base of the thumb — the first carpometacarpal joint — which causes the most functional difficulty.

Thumb base osteoarthritis is the one that matters most for daily life, because the thumb is involved in essentially every grip. Opening jars, turning keys, using taps, holding a book, doing up buttons — all become painful, and people quietly stop doing them.

It is worth distinguishing from inflammatory arthritis: rheumatoid arthritis typically affects the metacarpophalangeal and proximal interphalangeal joints, spares the distal joints, is symmetrical, and comes with prolonged morning stiffness of more than an hour and systemic symptoms. That distinction matters because rheumatoid arthritis needs early disease-modifying treatment.

What helps the hands

Thumb base orthoses. A neoprene or custom splint for the first carpometacarpal joint has reasonable evidence for pain reduction and is one of the more effective interventions available. Worn during aggravating activity rather than continuously.

Hand exercise programmes improve grip strength and function modestly.

Joint protection and adaptive equipment. This is where the largest functional gains usually come from, and it is under-prescribed. Jar openers, tap turners, thicker-handled cutlery and pens, key turners, electric tin openers, lever taps. Occupational therapy assessment is genuinely valuable here.

Topical NSAIDs, which are effective for hand osteoarthritis and avoid systemic exposure.

Heat before activity, which many people find helps stiffness.

Nodes themselves do not usually require treatment; they are often painful during the initial inflammatory phase of formation and settle over months into a painless deformity.

The general point

Osteoarthritis at any joint responds to the same principles — load the joint, strengthen what supports it, manage weight, use topical treatment before systemic, and adapt the task rather than abandoning it.

What changes between joints is which muscles matter and which daily tasks are threatened. Identifying the second of those is usually more useful than any imaging.