Scientific/Clinical Article| Volume 32, ISSUE 2, P153-164.e2, April 2019

Conservative therapeutic interventions for osteoarthritic finger joints: A systematic review


      • The current evidence generally supports the use of active range of motion, some resistive exercises, and joint protection as interventions for individuals with osteoarthritis (OA) finger joints.
      • The current evidence generally supports modalities such as electromagnetic therapy, paraffin wax, and balneotherapy (combined and/or not combined with mud packs and magnetotherapy) as effective interventions for individuals with OA finger joints.
      • The current evidence generally supports distal interphalangeal joint orthoses as effective treatment interventions for individuals with OA finger joints.


      Study Design

      Systematic review.


      Hand osteoarthritis (OA) is a chronic and disabling disease causing pain and functional limitations in approximately 54%-67% of the adult population aged 55 years and older.

      Purpose of the Study

      The objective of the study is to evaluate the evidence supporting conservative therapeutic interventions for the treatment of OA finger joints.


      Eighteen studies dated between 1979 and 2016 were identified meeting the inclusion criteria. They were analyzed based on Structured Effectiveness for Quality Evaluation of a Study, level of evidence, and effect size.

      Results and Conclusions

      The current evidence varies in quality and effect sizes but generally supports the use of active range of motion and resistive exercises, joint protection, electromagnetic therapy, paraffin wax, and balneotherapy (combined and/or not combined with mud packs and magnetotherapy), and distal interphalangeal orthoses as effective treatment interventions for individuals with OA finger joints.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Therapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kloppenburg M.
        Hand osteoarthritis-nonpharmacological and pharmacological treatments.
        Nat Rev Rheumatol. 2014; 10: 242-251
        • Dahaghin S.
        Prevalence and pattern of radiographic hand osteoarthritis and association with pain and disability (the Rotterdam study).
        Ann Rheum Dis. 2005; 64: 682-687
        • Kaufmann R.
        • Lögters T.
        • Verbruggen G.
        • Windolf J.
        • Goitz R.
        Osteoarthritis of the distal interphalangeal joint.
        J Hand Surg. 2010; 35: 2117-2125
        • Zhang Y.
        • Jordan J.M.
        Epidemiology of osteoarthritis.
        Clin Geriatr Med. 2010; 26: 355-369
        • Lawrence R.C.
        • Felson D.T.
        • Helmick C.G.
        • et al.
        Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II.
        Arthritis Rheum. 2008; 58: 26-35
        • Zhang Y.
        • Niu J.
        • Kelly-Hayes M.
        • Chaisson C.
        • Aliabadi P.
        • Felson D.
        Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: the Framingham study.
        Am J Epidemiol. 2002; 156: 1021-1027
        • Altman R.
        • Alarcon G.
        • Appelrouth D.
        • et al.
        The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand.
        Arthritis Rheum. 1990; 33: 1601-1610
        • Schiller A.
        Bones and Joints.
        in: Rubin E. Faber J. Essential Pathology. 2nd ed. Lippincott, Philadelphia, PA1995: 667-710
        • Gleason C.
        • Crump G.
        • Schneider P.
        Arthritis of the Hand and Upper Extremity in the Workplace.
        in: Kasden M. Occupational Hand and Upper Extrem Inj and Diseases. Hanley & Belfus, Philadelphia, PA1998: 233-245
        • Stern P.
        • Ho S.
        Osteoarthritis of the proximal interphalangeal joint.
        Hand Clin. 1987; 3: 405-413
        • Stabler A.
        • Heuck A.
        • Reiser M.
        Imaging of the hand: degeneration, impingement, and overuse.
        Eur J Radiol. 1997; 25: 118-128
        • Strickland J.
        • Idler R.
        • Creighton Jr., J.
        Osteoarthritis of the proximal interphalangeal joint.
        Indiana Med. 1990; 83: 908-910
        • Tiger L.
        Diagnosis and management of osteoarthritis.
        Compr Ther. 1986; 12: 30-35
        • Jacobs M.
        • Chinchalkar S.
        • Pipicelli J.
        in: Jacobs M. Austin N. Orthotic Intervention for the Hand and Upper Extremity Splinting Principles and Process. 2nd ed. Lippincott Williams & Wilkins, Baltimore, MD2014: 444-479
        • Estes J.
        • Bochenek C.
        • Fasler P.
        Osteoarthritis of the fingers.
        J Hand Ther. 2000; 13: 108-123
        • Fife R.
        Osteoarthritis Epidemiology, Pathology, and pathogenesis.
        in: Klippel J. Weyland C. Wortman R. Primer on Rheumatic Diseases. 11th ed. Arthritis Foundation, Atlanta, GA1997: 216-217
        • Scott D.
        Arthritis in the Elderly.
        in: Tallis R. Fillit H. Brochlehurts J.C. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 5th ed. Churchill Livingstone, New York, NY1998: 1155-1178
        • Bukhave E.
        • la Cour K.
        • Huniche L.
        The meaning of activity and participation in everyday life when living with hand osteoarthritis.
        Scand J Occup Ther. 2014; 21: 24-30
        • Hill S.
        • Dziedzic K.
        • Ong B.
        The functional and psychological impact of hand osteoarthritis.
        Chronic Illn. 2010; 6: 101-110
        • Stamm T.
        • van der Giesen F.
        • Thorstensson C.
        • et al.
        Patient perspective of hand osteoarthritis in relations to concepts covered by instruments measuring functioning: a qualitative European multicenter study.
        Ann Rheum Dis. 2009; 68: 1453-1460
        • Stamm T.
        • Machold K.
        • Smolen J.
        • et al.
        Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: a randomized controlled trial.
        Arthritis Rheum. 2002; 47: 44-49
        • Boustedt C.
        • Nordenskiöld U.
        • Lundgren N.
        Effects of a hand-joint protection programme with an addition of splinting and exercise: one year follow-up.
        Clin Rheumatol. 2009; 28: 793-799
        • Kjeken I.
        • Darre S.
        • Slatkowsky-Cristensen B.
        • et al.
        Self-management strategies to support performance of daily activities in hand osteoarthritis.
        Scand J Occup Ther. 2013; 20: 29-36
        • Valdes K.
        • Marik T.
        A systematic review of conservative interventions for osteoarthritis of the hand.
        J Hand Ther. 2010; 23: 334-351
        • Watt F.
        • Kennedy D.
        • Carlisle K.
        • et al.
        Night-time immobilization of the distal interphalangeal joint reduces pain and extension deformity in hand osteoarthritis.
        Rheumatology. 2014; 53: 1142-1149
        • Dziedzic K.
        • Nicholls E.
        • Hill S.
        • et al.
        Self-management approaches for osteoarthritis in the hand: a 2×2 factorial randomized trial.
        Ann Rheum Dis. 2015; 74: 108-118
        • Hennig T.
        • Hæhre L.
        • Hornburg V.
        • Mowinckel P.
        • Norli E.
        • Kjeken I.
        Effect of home-based hand exercises in women with hand osteoarthritis: a randomized controlled trial.
        Ann Rheum Dis. 2015; 74: 1501-1508
        • Kanat E.
        • Alp A.
        • Yurtkuran M.
        Magnetotherapy in hand osteoarthritis: a pilot trial.
        Complement Ther Med. 2013; 21: 603-608
        • Lefler C.
        • Armstrong W.
        Exercise in the treatment of osteoarthritis in the hands of the elderly.
        Clin Kinesiol J Am Kinesiotherapy Assoc. 2004; 58: 13-17
        • Rogers M.
        • Wilder F.
        The effects of strength training among persons with hand osteoarthritis: a two-year follow-up study.
        J Hand Ther. 2007; 20: 244-250
        • Dilek B.
        • Gözüm M.
        • Şahin E.
        • et al.
        Efficacy of paraffin bath therapy in hand osteoarthritis: a single-Blinded randomized controlled trial.
        Arch Phys Med Rehabil. 2013; 94: 642-649
        • Fioravanti A.
        • Tenti S.
        • Giannitti C.
        • Fortunati N.
        • Galeazzi M.
        Short- and long-term effects of mud-bath treatment on hand osteoarthritis: a randomized clinical trial.
        Int J Biometeorol. 2014; 58: 79-86
        • Horváth K.
        • Kulisch Á.
        • Németh A.
        • Bender T.
        Evaluation of the effect of balneotherapy in patients with osteoarthritis of the hands: a randomized controlled single-blind follow-up study.
        Clin Rehabil. 2011; 26: 431-441
        • Kovács C.
        • Pecze M.
        • Tihanyi Á.
        • Kovács L.
        • Balogh S.
        • Bender T.
        The effect of sulphurous water in patients with osteoarthritis of hand. Double-blind, randomized, controlled follow-up study.
        Clin Rheumatol. 2012; 31: 1437-1442
        • Baltzer A.
        • Ostapczuk M.
        • Stosch D.
        Positive effects of low level laser therapy (LLLT) on Bouchard's and Heberden's osteoarthritis.
        Lasers Surg Med. 2016; 48: 498-504
        • Basford J.
        • Sheffield C.
        • Mair S.
        • Ilstrup D.
        Low-energy helium neon laser treatment of thumb osteoarthritis.
        Arch Phys Med Rehabil. 1987; 68: 794-797
        • Paolillo A.
        • Paolillo F.
        • João J.
        • João H.
        • Bagnato V.
        Synergic effects of ultrasound and laser on the pain relief in women with hand osteoarthritis.
        Lasers Med Sci. 2015; 30: 279-286
        • Ikeda M.
        • Ishii T.
        • Kobayashi Y.
        • Mochida J.
        • Saito I.
        • Oka Y.
        Custom-made splint treatment for osteoarthritis of the distal interphalangeal joints.
        J Hand Surg. 2010; 35: 589-593
        • Garfinkel M.
        • Schumacher Jr., H.
        • Husain A.
        • Levy M.
        • Reshetar R.
        Evaluation of a Yoga based regimen for treatment of osteoarthritis of the hands.
        J Rheumatol. 1994; 21: 2341-2343
        • Swezey R.
        • Spiegel T.
        • Cretin S.
        • Clements P.
        Arthritic hand response to pressure gradient gloves.
        Arch Phys Med Rehabil. 1979; 60: 375-377
        • Zelazny C.
        Therapeutic instrumental music playing in hand rehabilitation for older adults with osteoarthritis: four case studies.
        J Music Ther. 2001; 38: 97-113
        • Sackett D.L.
        • Strauss S.E.
        • Richardson W.S.
        • Rosenberg W.
        • Hayes R.B.
        Evidence-based Medicine. How to Practice and Teach EBM.
        2nd ed. Churchill Livingstone, Toronto, ON2000
        • MacDermid J.
        An introduction to evidence based practice for hand therapists.
        J Hand Ther. 2004; 17: 105-117
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        2nd ed. Lawrence Erlbaum, Hillsdale, N.J1988

      JHT Read for Credit

      Quiz: # 603

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • #1.
        The study design is
        • a.
        • b.
        • c.
          a case series
        • d.
          a systematic review of existing literature on the topic
      • #2.
        Using X-ray verification techniques it has been shown that in adults over 55 years of age there is an approximately _____________ % likelihood of having OA of the small joints of the hand
        • a.
        • b.
        • c.
        • d.
      • #3.
        The distribution of OA is
        • a.
          approximately the same in the DIPs and PIPs
        • b.
          significantly greater in the PIPs than the DIPs
        • c.
          significantly greater in the DIPs than the PIPs
        • d.
          most pronounced in the MPs
      • #4.
        In addition to statistical and clinical significance, the authors looked at the
        • a.
          degree of difficulty in applying the techniques described
        • b.
          effect size of each study
        • c.
          popularity of the concepts described
        • d.
          availability of the journals containing each study
      • #5.
        Modest evidence was found to support resistive exercise to improve ROM and grip strength
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.