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 joint is the middle joint in the fingers
• the metacarpophalangeal 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 — known as 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
• a reduced range of motion in the affected joints
• nail or skin changes, if psoriatic arthritis is present
• crepitus, which refers to cricking or cracking sensations that occur as the joint moves

Without treatment, inflammation in the DIP joint may lead to permanent structural changes in the joints.

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 is also linked 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, of which smoking is a risk factor.

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 the 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, which is known as dactylitis, and enthesitis, which is when inflammation occurs 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.

• Long-term medication: These include etanercept (Enbrel), a biologic drug, which can help manage symptoms, prevent flares, and slow the progress of inflammatory diseases, such as psoriatic or rheumatoid arthritis.
• Options to manage pain: These include nonsteroidal anti-inflammatory drugs, such as ibuprofen.
• Corticosteroid injections: These 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: These can help soothe joints and reduce inflammation.
• Exercises: A doctor may recommend hand exercises, physical therapy, or both to help maintain mobility and range of motion.
• Dietary changes: These can help manage weight and ensure a supply of essential nutrients.
• Devices: A person may need a supportive device, such as a walker or a cane, to help them stay mobile.

A 2019 study noted that using a tin alloy splint on the affected finger is a safe and straightforward way to help reduce symptoms of DIP joint pain.

Surgery may be an option if symptoms are leading to structural joint issues. Surgery may aim to remove bone growths, reconstruct the joint, or fuse bones 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, which is when inflammation affects the place where ligaments and tendons meet a joint.

Why do I have distal interphalangeal joint pain in only one finger?

A person can have DIP joint pain in one finger. The reason why some people have this pain in one digit, while others have multiple fingers affected, is unknown. A mix of genetics and environmental factors is likely the cause.

DIP joint pain is a common symptom of arthritis, typically due to 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 needs to consult a doctor. Early diagnosis and treatment can help manage symptoms or slow the condition’s progress.