Managing Knuckle Pain: Relief and Recovery Based on Cause

A knuckle is a finger joint. Like other joints, it can experience injury or be affected by a health problem. Each of your fingers has three knuckles, and your thumb has two. 

The knuckles are called the metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints, and distal interphalangeal (DIP) joints. The MCP joints connect the fingers to the hand, while the PIP joints are the middle joints of the fingers. DIP joints are the closest to the fingertips. Any of these knuckles can experience pain.

Knuckle pain has various causes, including arthritis, an injury, or an infection. In addition to pain, the knuckles might be swollen, tender, and stiff. Managing and treating knuckle pain depends on the severity and underlying cause. 

This article will cover the possible causes of knuckle pain, symptoms, treatment options, and more. 

Knuckle Pain Causes

Arthritis is the most common cause of knuckle pain. For some people, knuckle pain is one of the earliest signs of arthritis.

Different types of arthritis can lead to knuckle pain, including:

• Osteoarthritis (OA)
• Rheumatoid arthritis (RA)
• Psoriatic arthritis (PsA)
• Gout

Non-arthritic causes of knuckle pain include:

• Injury
• Tendonitis
• A cyst
• An infection

Arthritis 

Arthritis pain and other symptoms may affect just one knuckle to start, but over time, you will have pain in other parts of your hands and fingers and various joints throughout the body. 

OA is the most common type of arthritis. It is known as wear-and-tear arthritis and can cause knuckle pain due to joint cartilage wearing away. It often affects the DIP and PIP joints and joints at the base of your thumb (where the thumb and hand meet).

RA is an autoimmune arthritis that occurs when the immune system malfunctions and attacks healthy tissue—mainly the synovial linings of joints. RA can affect the hands, wrists, and fingers, especially early in the disease process.

The most commonly affected joints of the hands in RA are the MCP joints—the knuckles at the base of the fingers where they meet the hand. People with RA will have symmetrical symptoms (the same finger joints affected on both sides), including swelling, warmth, and redness in the affected knuckles.

Like RA, PsA is an autoimmune arthritis that can affect the hands and fingers. It is sometimes linked to an autoimmune skin condition called psoriasis. When PsA affects these small joints, it can cause swelling, stiffness, and inflammation. PsA typically causes swelling in the PIP joints and deformities at the DIP joints.

Gout occurs when urate crystals accumulate in a joint, causing inflammation and intense pain. While gout often affects the big toe, it can also develop in the finger joints and cause knuckle pain.

Non-Arthritic Causes  

Any injury in the fingers or the hand can lead to knuckle pain.

A finger dislocation means that following an injury (usually a fracture or bone break), the bones of the finger joints are moved from their regular positions—most often in the middle knuckle of the little, ring, middle, or index finger. If you have dislocated a finger, your finger bones may bend in unusual ways, and the affected knuckle areas will be swollen and painful.

Tendonitis can occur from repetitive overuse or injury of a tendon in the finger joints. It can lead to tenosynovitis, which is tendinitis with inflammation of the tendon sheath lining.

Tenosynovitis can cause pain in the affected finger and knuckle, a bump in the affected area, swelling, warmth, redness, and cracking or snapping with bending the finger. It causes the finger or thumb to appear locked in a bent position (as if you are about to pull a trigger), which is why it is also called trigger finger.  

A ganglion cyst is a fluid-filled sac below the skin near a joint. These cysts can affect any area of the body but are most common on the wrist and hands. When they occur in the fingers, they form in the tendon sheath at the finger's base or knuckle.

The cyst can cause pain with movement, especially if the cyst is pressing on a nerve. Additional symptoms include tingling, numbness, and muscle weakness. 

If bacterium or virus enters the body through an open wound, it can lead to an infection. Any skin area can be affected, including around and near the knuckles. Signs of an infection of the hands or fingers include bone and knuckle pain, fever and chills, general discomfort or a general unwell feeling, and local swelling, stiffness, and warmth.

Infections that might affect finger joints and cause knuckle pain include:

• Cellulitis, which can occur near a cut or open skin area
• Human papillomavirus (HPV), which leads to warts on the fingers and knuckles 
• Impetigo, an infection of the skin
• Osteomyelitis, which is a bone infection 
• Septic arthritis, which is a severe infection inside a joint
  

Other Health Conditions 

Some health conditions may cause pain, stiffness, and joint pain in the fingers and knuckles. For example, diabetes can lead to nerve damage in the hands and fingers, which often leads to knuckle pain.

Diabetes can also lead to musculoskeletal disorders, including tenosynovitis and carpal tunnel syndrome. It may also increase a person's risk for an infection of the hands or fingers or vascular (blood vessel) complications of the hands.

Symptoms: How Does Knuckle Pain Feel?

Knuckle pain may affect one or multiple knuckles. Symptoms of knuckle pain may vary depending on the condition causing it. In general, however, knuckle pain may be accompanied by stiffness, which makes it harder to bend or move the affected fingers. 

Knuckle pain may also be accompanied by swelling and redness. You may feel a dull ache or severe stabbing pain in the fingers even when not using the hands.

If you have an injury, break, or dislocation of a finger joint, you might experience:

• Limited or no range of motion
• Numbness and tingling 
• Bruising
• Swelling 
• Discoloration 
• An affected finger that appears bent or at an abnormal angle
  

Knuckle Pain Treatment Options

Your treatment for your knuckle pain will depend on what is causing it. 

Arthritis 

Conditions like RA and PsA are treated with medications called disease-modifying antirheumatic drugs (DMARDs) that work to stop or slow down the processes that lead to inflammation and swelling of joints. Corticosteroids might be given orally or by injection to help manage flare-ups of disease symptoms and pain.

Gout is treated with nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation, corticosteroids (orally or by injection) to manage gout attacks, and colchicine to treat gout pain.

Medicinal treatments for OA include over-the-counter (OTC) pain relievers, including NSAIDs, topical treatments to apply to the skin over the affected joints, and prescription corticosteroids to reduce inflammation and pain. 

Hand therapy can help manage knuckle pain caused by arthritis. A physical therapist can create a treatment plan that includes hand, wrist, and finger exercises. These exercises can help relieve pain and allow you to continue your daily activities.

If knuckle pain isn't resolved with conservative therapies, your healthcare provider might recommend surgery to repair or replace a damaged finger joint affected by arthritis.

Joint fusion surgeries are typically used to treat the small joints of the fingers. This procedure involves removing the ends of two bones that form a joint and then joining them together—often with plates, screws, pins, or wires—to heal as one.

An Injury

A dislocated finger may be treated with pain medication, anesthetics, splinting, or taping to immobilize the finger. Your healthcare provider may want to reset the joint, manually or surgically, to prevent deformity.

Hand surgery might be needed if the joint does not properly heal or if you continue to have knuckle pain.

Tendonitis

Tendonitis is treated with pain relievers and corticosteroids. It is sometimes treated with platelet-rich plasma. This treatment involves taking a sample of your blood and spinning the blood in a machine to separate platelets and other healing compounds. This solution is then injected into the area of the affected tendon. 

Physical therapy might help strengthen muscles and tendons. If physical therapy does not help resolve symptoms, your healthcare provider might recommend dry needling.

This involves ultrasound guidance to make small holes in the tendon with a fine needle to stimulate healing. Surgery is a last resort option, performed when other treatments have failed.

Ganglion Cyst

Some ganglion cysts are painless and will not need treatment. In this case, your healthcare provider will recommend watching the cyst for changes. 

If the cyst causes knuckle pain or affects finger joint movement, your healthcare provider may recommend a brace or splint to keep the joint still until the cyst shrinks. The cyst can also be drained with a needle but may return. 

Surgery might be considered if other approaches do not work. Surgical treatment involves removing the cyst and the stalk attached to the joint or tendon.

Infections

Treatment for an infection of the hand or finger joints will depend on the source of the infection and its severity. Some skin infections can be treated with OTC skin creams, but if an infection is severe, your healthcare provider may prescribe additional medications.

Medications used to treat skin, bone, and joint infections of the hands and fingers include:

• Antibiotics to treat bacterial infections
• Antifungals to treat infections caused by a fungus
• Antiparasitics to treat infections caused by parasites such as protozoa
• Antivirals to treat viruses

Your healthcare provider will prescribe these treatments to be taken orally at home. However, if you have a severe infection or you are someone with underlying health conditions or a weak immune system, treatment might be administered in a hospital setting.

Other Conditions 

If diabetes is the cause of knuckle pain, it is vital to get your diabetes under control and manage any complications of the condition. Managing joint and nerve complications of diabetes involves medicine, physical therapy, and surgery as a last resort.

Home Remedies and Self-Care for Knuckle Pain

Knuckle pain can be managed at home with some basic self-care methods.

Such options include: 

• Applying heat and ice to an inflamed or injured knuckle
• Taking OTC pain relievers
• Stretching and massaging affected finger joints 
• Reducing stress by avoiding stress triggers and with deep breathing and meditation 

How to Manage Ongoing Knuckle Pain 

If you experience persistent knuckle pain, consider ways to prevent worsening pain. For example, if arthritis is the cause of knuckle pain, making changes to your daily routine might help. Consider using a keyboard rather than writing by hand. Also, you can use pens, pencils, and cutlery with modified grips to reduce pain in affected knuckles.

Compression gloves—designed to reduce hand pain—can help you complete daily tasks with less hand and finger pain. You can also wear them at night to help improve sleep and joint stiffness and pain. Wear gloves in cold weather and hand gear while playing sports to prevent and manage hand and finger pain.

Taking frequent breaks when doing repetitive tasks that strain the knuckles might be another way to reduce knuckle pain. Stretching the hands and fingers several times throughout your day may also reduce pain and stiffness.

When to Seek Medical Attention

Contact your healthcare provider as soon as possible if you have concerns about your knuckle pain. This is especially important if your knuckle pain does not go away, worsens, or goes away and then returns. 

You should also seek treatment for a recent trauma to your hand or fingers or if you suspect an infection has invaded your hand's skin, bones, or joints. 

Your healthcare provider can examine your knuckles, fingers, and hands and order tests to determine the source of symptoms. 

Summary 

Knuckle pain has different causes, including arthritis and other conditions. You may experience pain in one or more of your knuckles from an injury to your hand or inflammation (related to arthritis and other inflammatory conditions) or an infection.

When a health condition causes knuckle pain, treating the underlying condition may ease the pain. For rheumatoid arthritis, psoriatic arthritis, and gout, treatment is vital to reduce pain and prevent joint damage from ongoing inflammation. These conditions are treated with specific medicines to manage inflammation and underlying disease processes.

Other treatments for knuckle pain include OTC oral and topical medicines, immobilization of the affected finger joint, hot and cold therapy, and hand therapy. To prevent or reduce ongoing knuckle pain, find ways to rest the hands and fingers, wear compression gloves, use modified grip tools, and stretch the hands and fingers often. 

Contact your healthcare provider for severe, persistent, or ongoing knuckle pain. They can examine your hands and fingers and advise you on treatment options.