PIP Joint Arthritis Info
Last reviewed
Osteoarthritis and inflammatory arthritis of the PIP joint — non-operative and surgical options.
What you're feeling
You likely feel pain in the middle joint of your finger, known as the proximal interphalangeal joint. This pain often comes from wear-and-tear arthritis or damage from a past injury. Your surgeon may suggest this surgery only if the pain becomes so severe that it stops you from doing daily tasks. You might notice the pain gets worse after you use your hand or when you wake up in the morning.
Simple actions can become very difficult. You may struggle to reach behind your back to fasten a bra or tuck in your shirt. The joint might feel stiff, making it hard to bend or straighten your finger fully. In some cases, the joint may not move as well as it used to, and this range of motion can get worse over time. If you have rheumatoid arthritis, early treatment with specific medicines can help improve how you feel.
While the disease process is complex, you can expect relief from pain and better function after surgery. Many patients find that surface replacement of the joint provides excellent relief with few problems. However, you should know that the movement in your finger might decrease slightly as time goes on. If you have a contracture where the finger is stuck bent, serial casting might help correct this before or after surgery. Your surgeon will review if this procedure is right for you based on your specific symptoms and joint condition.
What's actually happening
In your finger, the smooth coating on the bone ends, called cartilage, wears down over time. This wear-and-tear arthritis acts like a shock absorber that has lost its cushion. As the cartilage thins, the bones rub together, causing pain and stiffness. You may notice you move through a smaller range of motion when doing daily tasks because the joint no longer glides smoothly.
The problem goes deeper than just the bone. The tendons, which are like ropes of fibers connecting muscle to bone, change early in the disease. These tendons bridge multiple joints, so a change in one area affects how your whole finger moves. This interdependency means that when one part of your finger changes, the others struggle to keep up. Over time, these changes in the tendons and related structures lead to the deformities you see.
Your surgeon sees that this process is driven by how forces travel through your hand. Women with this condition often have significantly lower hand forces, with a mean decrease of 30% across most force types. Compressive shear forces can also damage the joint over time, leading to further wear. When the joint capsule, the sleeve around the joint, and the ligaments lose their stability, the bones shift. This shift creates the pain and limited function that bring you to see your surgeon.
What we can do about it
Your journey often begins with self-management and physiotherapy. If you have a stiff finger, serial casting is an effective method to correct flexion contractures in selected patients with arthritis. This process helps you regain movement without surgery. Your surgeon may also recommend exercises to keep the joint flexible. You should give these non-surgical options a fair chance before considering more invasive steps.
If simple care is not enough, your surgeon may discuss medical management. While the evidence does not detail specific drug names or injection types for this joint, it confirms that pain relief is a primary goal. For some, the focus remains on managing symptoms to maintain function. If arthritis causes invalidating functional pain, your surgeon might consider specific surgical options like the TACTYS prosthesis exceptionally. However, for many, the focus is on keeping the joint working well while managing discomfort.
When conservative care reaches its limit, surgery becomes a reliable option. Proximal interphalangeal joint implant arthroplasty is a good and reliable choice for symptomatic arthritis given the proper clinical setting. This procedure can provide reliable, long-term pain relief and maintenance of function. Most patients return to work after a median of 8 weeks following this surgery. While the joint may feel better, you should be advised that range of motion can deteriorate over time with certain implants. Your surgeon will help you decide if this is the right step for your specific finger.
When to see someone
Ask for a specialist review if you have persistent pain from wear-and-tear arthritis or post-traumatic arthritis that does not improve with rest. Seek help if you experience weakness, instability, or locking in your finger. Contact your doctor if symptoms interfere with your sleep or work. You should also seek advice if you notice a sudden worsening of your condition. Be aware that range of motion can deteriorate over time. If you have diabetes, discuss the higher risk of complications with your surgeon before considering surgery.
