Hand osteoarthritis (OA) is a frequent disease, which may lead to considerable pain and physical limitations. However, limited research has been performed in hand OA. Lately, modern imaging techniques, such as ultrasonography (US) and magnetic resonance imaging (MRI), have gained increasing attention in hand OA clinical research. Both modalities may provide important knowledge about the natural history and pathogenesis of the disease, in addition to serving as potential outcome measures in clinical trials. In clinical practice, the diagnosis of hand OA should be based on clinical examination and conventional radiography, if necessary. However, US and MRI can provide information about the degree of inflammation and exclude potential differential diagnoses.