Pain in the middle knuckle of the finger is usually caused by trauma from an injury or inflammation of the joints within the hand. Rheumatoid and psoriatic arthritis can cause swelling and knuckle pain. Read below for more information on causes and treatment options.
7 most common cause(s)
Pain in the middle knuckle of the finger symptoms
Pain in the middle knuckle of the finger, or any finger, is usually the result of swelling. Swelling is the result of fluid buildup that gets trapped in your body’s tissues. Most people first notice swelling because the affected body part may appear larger than normal.
Common characteristics of pain in the middle knuckle of the finger
Often a painful or swollen middle finger can be easily identified by comparing its size to the size of your other fingers; however, sometimes the swelling may not be visibly obvious and difficult to discern.
Common accompanying symptoms
If your pain is not accompanied by obvious swelling, you may experience other symptoms that may include:
- Stiffness
- Limited range of motion
- Stretched or shiny skin
- Skin pitting: Skin that dimples or pits after pressing on the affected area for a few seconds
- Warmth or redness of the affected area
- Visible deformity
If you notice any of these symptoms, make an appointment with your doctor promptly in order to follow up on your symptoms, get a diagnosis and receive appropriate care.
Causes of pain in the middle knuckle of the finger
Any condition that causes accumulation of fluid in the tissues of your finger will cause swelling and accompanying pain. Swelling can occur throughout the body due to a variety of causes, but swelling in just one part of the finger has limited triggers. A swollen finger or painful middle knuckle may not seem serious initially, but without prompt medical follow-up and care, your symptoms could worsen.
Inflammatory
Pain in the middle knuckle of the finger is often the result of injury and the resulting inflammatory response.
- Rheumatologic: This category includes inflammatory conditions involving the body’s tissues and joints. Conditions such as arthritis and gout cause inflammation that easily brings fluid into the tissues leading to swelling, redness, and tenderness of single fingers and often the big toe.
- Infections: The skin is home to many bacteria that can easily get into the finger via a cut, bite or other puncture. The bacteria will infect the tissues of the finger and cause entrance of fluids into the tissues that result in inflammation, swelling and other associated symptoms. Viral infections can also cause swelling of the finger in people with jobs that require exposure of the finger to body parts such as the mouth (dentists, nurses, healthcare professionals). This condition is known as herpetic whitlow.
Environmental
The finger is susceptible to many outside forces that can result in pain and injury.
- Trauma: Trauma to the finger that causes pain and swelling can include simple mishaps such as jamming one’s finger on a wall or serious accidents that result in broken bones.
- Weather: Sometimes extremely cold or hot weather can trigger swelling in people with pre-existing conditions such as Raynaud’s syndrome. Observe for any patterns in your finger swelling and tell your doctor in order to investigate an underlying condition.
This list does not constitute medical advice and may not accurately represent what you have.
Rheumatoid arthritis
Rheumatoid arthritis is a chronic inflammatory disorder that affects the lining of the joints, causing them to become thickened and painful. It can also affect other parts of the body such as the heart, lungs, eyes, and circulatory system.
Rheumatoid arthritis is an autoimmune disease, which means the body's immune system turns against itself for unknown reasons.
Most at risk are women from ages 30-60. Other risk factors are family history, smoking, and obesity.
Early symptom include warm, swollen, stiff, painful joints, especially the fingers and toes; fatigue; and fever. Usually, the same joints on both sides of the body are affected.
If untreated, irreversible joint damage and deformity can occur, with other complications. Early diagnosis can allow preventive treatment to begin as soon as possible.
Diagnosis is made through physical examination; blood tests; and x-ray, CT scan, or MRI.
There is no cure for rheumatoid arthritis, but the disease can be managed to improve quality of life. Treatment includes nonsteroidal anti-inflammatory drugs; steroids; anti-rheumatic drugs; physical therapy; and sometimes surgery to repair the joints.
Psoriatic arthritis
Psoriatic arthritis is a complication of psoriasis, which causes the skin to become thickened, red, and scaly. Arthritis may appear before or after the psoriasis appears.
Both conditions are autoimmune diseases, where the body attacks itself, and are thought to be caused by genetic and environmental factors.
Most susceptible are people from 30 to 50 years of age with a family history of the disease and who already have psoriasis.
Symptoms include the joints on one or both sides of the body becoming painful, swollen, and hot; swelling and deformity of the fingers and toes; pitted, flaking fingernails; foot pain in the heels and soles; and joint pain in the low back pain.
It is important to seek treatment, as psoriatic arthritis can permanently damage the joints, eyes, and heart.
Diagnosis is made through physical examination, x-rays, and MRI. Blood tests and joint fluid tests can confirm psoriatic arthritis.
Treatment includes over-the-counter, nonsteroidal anti-inflammatory drugs; anti-rheumatic medication; immunosuppressants; and steroid injections for the joints. Surgery to replace damaged joints may also be tried.
Polymyalgia rheumatica
Polymyalgia rheumatica (PMR) is a chronic condition that involves inflammation, aching pain, and morning stiffness. It affects muscles close to the middle of the body, including the shoulders, hips, and back. Its cause is not known, but it is more common in people over 50 years old.
You should consider visiting a healthcare provider within the next day to discuss your symptoms. PMR can be evaluated with a review of your symptoms and medical history. Your provider may also perform a blood test. Once diagnosed, it can be treated with prescription steroid medication, which can improve symptoms within one week.
Non-serious finger injury
Finger injuries are very common & rarely need medical treatment.
You can treat this at home with ice and rest. An X-ray would be necessary to rule out a fracture if you had swelling and difficulty moving the finger.
Rarity: Common
Top Symptoms: recent finger injury, finger pain from an injury, swollen finger, severe finger pain
Symptoms that always occur with non-serious finger injury: recent finger injury
Symptoms that never occur with non-serious finger injury: bent or crooked finger
Urgency: Self-treatment
Middle knuckle finger dislocation
The middle knuckle is called the proximal interphalangeal (PIP) joint. A PIP joint dislocation occurs when trauma causes the bones of the finger to dislodge, resulting in a very painful and swollen joint.
You should visit your primary care physician within the next 24 hours. This injury is very painful, and is usually treated by a hand specialist. Surgery is not usually required, and treatment consists of icing the affected area, splinting the finger, and anti-inflammatory and pain reducing drugs.
Rarity: Rare
Top Symptoms: bent or crooked finger, finger dislocation at the knuckle connected to the palm, pain in the middle knuckle of the finger, finger pain from an injury, swelling of the small knuckle of the dmiddle index finger
Symptoms that always occur with middle knuckle finger dislocation: bent or crooked finger, finger dislocation at the knuckle connected to the palm
Urgency: Primary care doctor
Jammed finger
Jammed fingers are common in sports but may occur during daily activity.
You should visit a physician or urgent care center in the next day. Generally, surgery is not required and splinting is sufficient.
Gout
Gout is a form of arthritis that causes sudden pain, stiffness, and swelling in a joint. The big toe is often affected, but it can also happen in other joints. Sometimes, the joint gets hot and red. Gout is caused by uric acid crystals. Risk factors for gout include obesity, eating a lot of meat, drinking beer, age (older), sex (male), and family history.
You should see a healthcare professional to see if uric acid crystals have accumulated in the joint. Gout can be diagnosed based on symptoms, but it's also common to take a sample of joint fluid for testing. A physician can give you a prescription for anti-inflammatory medications and/ or pain medications. There are also medications to stop your body from making too much uric acid. Sometimes, a shot in the joint can help with symptoms also.
Pain in the middle knuckle of the finger treatments and relief
At-home treatments
If you note pain in the middle knuckle of your finger after trauma such as jamming or hitting your finger:
- Rest, Ice and Elevate: Put an ice pack on your finger or place your finger in ice water every 15 minutes. Maintain your finger elevated and still to minimize further irritation and prevent continued fluid accumulation in your tissues.
- Protect: If the pain and swelling persist, you can protect the affected finger from further trauma by attaching it to an adjacent finger using tape or a self-adhesive wrap. The affected finger will be less likely to move which prevents further inflammation and fluid accumulation.
When to see a doctor
If your swollen finger persists for a prolonged period of time and worsens despite not seeming related to a traumatic event, make an appointment with your doctor. Depending on the cause your doctor may initiate:
- Antibiotics: Your doctor will prescribe antibiotics if your swollen finger is due to a bacterial infection. The antibiotics will combat the infection and allow the body to lessen its inflammatory response.
- Rheumatologic medications: There are many different types of medications that combat rheumatologic conditions that may be causing your swollen finger. Talk to your doctor to discuss and come to an agreement about the best type of treatment.
When it is an emergency
Seek medical care immediately if:
- Your finger appears deformed
- You cannot straighten your finger
- The area becomes hot and inflamed and you develop a fever
- Swelling and pain increases significantly and persists
- The finger becomes numb and turns white or pink
These symptoms may be related to a more serious cause such as a broken finger resulting in decreased blood flow to the finger and/or hand.
FAQs about pain in the middle knuckle of the finger
What is a rheumatoid nodule?
A rheumatoid nodule is one of the most common skin manifestations of rheumatoid arthritis. Rheumatoid arthritis is a chronic disease that causes inflammation of the joints and results in painful movement and stiffness, especially in the fingers, wrists, and ankles. Nodules are large, painful bumps that often develop in the joints of the fingers and also on the elbows, forearm, back, heel and many other areas.
What is a Heberden node?
A Heberden node is a common skin manifestation of osteoarthritis. Osteoarthritis is a chronic disease caused primarily by degeneration of joint cartilage. A Heberden node is a hard, bony swelling that results over time due to chronic degeneration and resulting inflammation. These nodes often occur in the middle and index fingers. See this image here of nodes in someone with osteoarthritis.
What is the difference between a middle finger fracture and a middle finger dislocation?
A fracture occurs when the bones in a body part break. A dislocation does not involve breaking bones but rather only displacement or misalignment of bones. The distinction is important as fractures and dislocations are treated differently. If you experience trauma to the finger that results in severe pain and visible deformity, make an appointment with your healthcare provider to get the appropriate diagnosis and care.
What is herpetic whitlow?
Herpetic whitlow is an infectious lesion on the finger or thumb caused by the herpes simplex virus. See an image of this type of lesion here. This is often a side effect of oral herpes infection and is a common hazard in occupational settings such as dentistry and healthcare where individuals are repeatedly exposed to infected secretions.
How can I prevent infection of my middle finger?
Proper hand hygiene is the key to preventing skin infection. Wash the hands regularly with soap and water, avoid putting the hands in the mouth and make sure to cover cuts and abrasions with bandages.
Questions your doctor may ask about pain in the middle knuckle of the finger
- Did you injure your finger?
- Do any of your body parts (e.g., toes, hands, ears) feel cold?
- Did you get a manicure and/or pedicure in the past few days?
- Where on your finger is the pain worst?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
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References
- Rheumatoid Arthritis Symptoms. Johns Hopkins Arthritis Center. Updated Aug. 16, 2017. Johns Hopkins Link
- Izzo S, Ahmed M. Herpetic Whitlow. The New England Journal of Medicine. 2014;271:e25. NEJM Link
- Osteoarthritis. U.S. National Library of Medicine: MedlinePlus. Updated Nov. 16, 2018. MedlinePlus Link
- Finger fractures. American Academy of Orthopaedic Surgeons: OrthoInfo. Updated December 2013. OrthoInfo Link
- Borchers JR, Best TM. Common finger fractures and dislocations. American Family Physician. 2012;85(8):805-810. AAFP Link