What to know about distal interphalangeal (DIP) joint pain

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The fingers have three joints:

• the DIP joint is the one nearest the tips of the fingers
• the proximal interphalangeal (PIP) joint is the middle joint in the fingers
• the metacarpophalangeal (MCP) joint, where the fingers attach to the palm

The DIP joint is the first knuckle from the top of the finger. It connects the distal phalanx and middle phalanx, which are the two bones at the tip of the finger.

Experiencing DIP joint pain is often a sign of a type of arthritis, such as osteoarthritis or psoriatic arthritis.

DIP joint pain can occur for several reasons, such as:

• psoriatic arthritis
• osteoarthritis
• rheumatoid arthritis, in some cases
• gout
• stenosing tenosynovitis (“trigger finger“), which usually affects joints in the fourth finger

The pain can result from:

• inflammation
• bone degeneration
• the formation of bony nodules known as Heberden’s nodes
• the formation of uric acid crystal deposits, in the case of gout
• trigger finger when inflammation causes the tendons to become caught in their sheaths, making it difficult and painful to move the top of the finger

Heberden’s nodes are bony nodules that form around a joint as cartilage erodes and bones rub together. They are a sign of more advanced osteoarthritis in the DIP joints.

A person experiencing pain in the DIP joint may describe the feeling as:

• stiff
• burning
• stuck
• swollen
• aching
• pain and stiffness in other hand joints

Other symptoms of arthritis might include:

• pain and swelling in the hands and feet
• pain and swelling in the fingers and toes
• reduced range of motion in the affected joints
• nail or skin changes, if psoriatic arthritis is present
• crepitus, cricking or cracking sensations that occur as the joint moves

Without treatment, inflammation in the DIP joint may lead to permanent deformity.

Learn about how to identify and manage arthritis in the hands.

DIP joint pain is often due to arthritis, usually osteoarthritis or psoriatic arthritis.

Osteoarthritis occurs when the cartilage in the joints wears down and typically does not have an inflammatory cause. The risk of osteoarthritis increases with age, and obesity is an added risk factor.

Psoriatic arthritis causes inflammation due to a response in the immune system. Psoriatic arthritis also has a link to the skin condition psoriasis, and a person with the condition will likely experience skin symptoms as well.

Less commonly, DIP joint pain can occur with rheumatoid arthritis. Smoking is a risk factor for rheumatoid arthritis.

To diagnose the underlying cause of DIP joint pain, a doctor will start by:

• asking about symptoms
• asking about personal and family medical history
• carrying out a physical examination of joints

Doctors may also recommend imaging tests:

• X-rays may help confirm the presence of Heberden’s nodes in the DIP
• an MRI or ultrasound can help reveal connective and soft tissues in the joints
• blood tests may show signs of inflammation and immune activity
• a skin biopsy can assess for psoriasis

These tests can help identify the cause of DIP joint pain.

If the doctor suspects psoriatic arthritis, they will inspect the skin for signs of psoriasis. DIP joint pain can be an early sign of psoriatic arthritis, and psoriasis is a risk factor for psoriatic arthritis.

Other signs of psoriatic arthritis include swollen fingers (dactylitis) and enthesitis (inflammation where tendons attach to the joints).

Doctors treat DIP joint pain according to the underlying cause. If they diagnose arthritis, the approach will depend on the type of arthritis.

• Long-term medication, such as etanercept (Enbrel), a biologic drug, can help manage symptoms, prevent flares, and slow the progress of inflammatory diseases, such as psoriatic or rheumatoid arthritis.
• Options to manage pain include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
• Corticosteroid injections can help reduce pain and inflammation in some cases. However, they are only for short-term use due to possible adverse effects.
• Heat and cold packs can help soothe joints and reduce inflammation.
• A doctor may recommend hand exercises, physical therapy, or both to help maintain mobility and range of motion.
• Dietary changes can help manage weight and ensure a supply of essential nutrients.
• A person may need a supportive device, such as a walker or a cane, to help them stay mobile.

A study in the journal Rheumatology noted that short-term splinting, such as splinting the affected finger during the night, is a safe and straightforward way to help reduce symptoms and help the finger extend.

Surgery may be an option if symptoms are leading to deformity. Surgery may aim to remove bone growths, reconstruct the joint, or fuse bones together if necessary. Surgery can help restore hand function and minimize pain.

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Here are some questions people often ask about DIP joint pain.

What causes DIP joint pain?

DIP joint pain usually results from arthritis, particularly osteoarthritis or psoriatic arthritis. It results from inflammation, bone erosion, the formation of bony nodules on the joint, and swelling in tendons and ligaments where they attach to the joint.

What is the link between DIP joint pain and osteoarthritis?

When a person has osteoarthritis, the cartilage around a joint wears away, and friction occurs as the bones rub together. Sometimes, body spurs, known as Heberden’s nodes, can develop, and inflammation can occur. Together, these can lead to pain in the DIP joint.

What is the link between DIP joint pain and psoriatic arthritis?

Psoriatic arthritis is an inflammatory disease that commonly involves the DIP joints. Inflammation can cause the joints to become swollen and painful. One reason for this is enthesitis. This is when inflammation affects the place where ligaments and tendons meet a joint.

DIP joint pain is a common symptom of arthritis, typically either osteoarthritis or psoriatic arthritis.

The person may also experience symptoms in other joints in their hands, feet, or other areas of the body. Someone with psoriatic arthritis might experience symptoms on their skin, as well.

Anyone experiencing DIP joint pain or other symptoms of arthritis should see a doctor. Early diagnosis and treatment can help manage symptoms or slow the progress of the condition.