Summary Arthritis of the DIP and PIP joints are very common forms of osteoarthritis seen in the hand and can be associated with pain and deformity. Diagnosis is made radiographically with joint space narrowing seen in the DIP and PIP joints of the fingers. Mucous cysts are often present on clinical inspection of the DIP joint. Treatment is observation if patient is minimally symptomatic. Operative mucous cyst excision, osteophyte resection, or joint fusion may be indicated depending on severity of symptoms and the stage of disease. Epidemiology Incidence Common DIP arthritis is the most common arthritis of the hand login to view 1 more bullet Etiology Forms include primary osteoarthritis DIP login to view 11 more bullets PIP login to view 2 more bullets erosive osteoarthritis condition is self limiting, patients are relatively asymptomatic, but can be destructive to joint more common in DIP seen in middle aged women with a 10:1 female to male ratio Presentation Symptoms of primary osteoarthritis pain deformity Symptoms of erosive osteoarthritis intermittent inflammatory episodes articular cartilage and adjacent bone destroyed synovial changes similar to RA but not systemic Imaging Radiographs recommended views AP, lateral and oblique of hand findings erosive osteoarthritis will show cartilage destruction, osteophytes, and subchondral erosion (gull wing deformity) Diagnosis Radiographic diagnosis confirmed by history, physical exam, and radiographs Treatment DIP Arthritis nonoperative observation, NSAIDs login to view 2 more bullets operative fusion login to view 9 more bullets Mucous Cyst nonoperative observation login to view 2 more bullets operative mucous cyst excision + osteophyte resection login to view 5 more bullets PIP Arthritis nonoperative observations, NSAIDs login to view 2 more bullets operative collateral ligament excision, volar plate release, osteophyte excision login to view 2 more bullets fusion login to view 7 more bullets silicone arthroplasty for middle and ring PIPJ login to view 9 more bullets Erosive osteoarthritis nonoperative splints, NSAIDs login to view 2 more bullets operative fusion login to view 4 more bullets