8 Exercises for people with osteoarthritis (OA) or rheumatoid arthritis (RA)

Hand and Finger Exercises for Arthritis article - MasterfileBrushing your teeth, buttoning your shirt, opening a jar—these are routine daily activities that most people take for granted. But if you have arthritis and it affects your hands, performing these and other basic tasks can be challenging. Fortunately, "exercising" your hands can help reduce the pain, improve your range of motion, and, ultimately, enable you to perform more easily the various tasks of daily living.

Do You Have Osteoarthritis or Rheumatoid Arthritis?

Arthritis of the hands manifests differently depending on what kind of arthritis you have.

Osteoarthritis. The most common cause of hand arthritis is osteoarthritis (OA). In OA, the protective cartilage that covers the ends of your bones gradually deteriorates due to wear and tear or, in some cases, to injury. If your hand pain is caused by OA, the affected joints are painful and may swell or develop hard bony nodules (Heberden's and Bouchard's nodes).

The joints most likely to be affected in hand OA are the trapezio­metacarpal (basilar) joint, which is at the base of the thumb; the distal interphalangeal joint, which is closest to the fingertips; and the proximal interphalangeal joint, located in the middle of the finger.

Rheumatoid arthritis. By contrast, rheumatoid arthritis (RA) is an immune system disorder that damages the cells in the tissue that lines and lubricates the joints (synovial membrane).

If RA is the cause of your hand pain, the joints most likely to be affected are the wrist joints; the index and middle metacarpophalangeal joints, which are the knuckles at the base of your fist; and the proximal interphalangeal joints.

RA does not affect the distal interphalangeal joints. In addition, because RA is a systemic condition, it typically affects joints on both sides of the body.

In advanced RA of the hand, various deformities may develop. For example, in a condition known as Boutonniere deformity, the proximal interphalangeal joint flexes and can’t be straightened, while the distal interphalangeal joint extends back away from the palm. Another example is flexor tenosynovitis, also known as trigger finger. In this condition, the finger becomes frozen in a bent position, as if poised on the trigger of a gun.

The distinction between OA-­ and RA-­induced hand pain is important for several reasons. First, if your pain is caused by RA, don’t attempt to alleviate it with exercise alone. Prompt aggressive treatment with disease-­modifying antirheumatic drugs (DMARDs) has been shown to slow disease progression and limit joint damage, reducing the likelihood that your hand will become permanently disfigured. Second, strengthening exercises can be harmful if per­ formed aggressively and should be done in moderation by people with RA. Third, you should perform any type of exercise with caution while you’re having a flare. The main message for people with RA or OA is to respect the pain and when­ ever you perform the exercises, do them gently to avoid further harm to your joints.

Hand Exercises: How to's

Ask your doctor if it's safe for you to try the exercises below. Or consider asking for a referral to a physical therapist (PT) or occupational therapist (OT), who can design a program specifically for you. A PT or OT who is also a certified hand therapist (CHT) has extensive training and experience in hand therapy. A CHT can also advise you on other therapies that might be helpful, such as the use of adaptive equipment, protective splinting, and other techniques to reduce pain and swelling.

The exercises here were recommended by Monique Turenne, OTR/L, a certified hand therapist at Johns Hopkins Hospital's Department of Physical Medicine and Rehabilitation. Most of the exercises help improve range of motion, but two are muscle­-strengthening exercises. She advises doing a few slow repetitions once a day as pain permits and gradually increasing to 10 slow repetitions. If both hands are affected, repeat the exercise on both your right and left hand.

To reduce pain before you perform the exercises, try soaking your hands in warm water or dipping them in warm paraffin wax. You may even want to try performing some of the exercises with your hands submerged in warm water or while you’re in a heated pool. This is a gentle way to exercise joints and muscles. The buoyancy of the water sup­ports and lessens stress on the joints, enabling you to move your hands more easily. Water may also act as resistance to help build muscle strength.

finger-joint-blocking-jhm.gifFinger Joint Blocking

A) Lay your hand palm side up on a table. With your opposite hand grasp and hold the affected finger at the middle section just below the end joint. Bend and straighten the finger at the end joint only while holding the rest of the finger straight. Repeat for each finger. B) With your hand in the same starting position, bend and straighten the finger at the middle joint only, while holding the rest of the finger straight. Repeat for each finger.

wrist-bend-jhm.gif

Wrist Bend

With your arm outstretched bend your wrist backward, then forward.

Finger Touch

finger-tip-touch-jhm.gifStarting with an open hand, touch your thumb to the pad just below your pinkie finger. Release and then touch your thumb to the tip of your pointer finger, ring finger, index finger, and pinkie finger, in sequence.

thumb-stretch-jhm.gif

Thumb Stretch

Start with your hand outstretched. Bend your thumb toward the base of your pin­ kie finger. Return to original position.

wrist-turn-jhm.gifWrist Turn

With your arm outstretched, turn your palm toward the ceiling, then turn it down to face the floor.

muscle-strength-1-jhm.gif

 Muscle Strengthener 1

Hold a piece of paper or a newspaper by the corner, and using only one hand, crumble it into a ball as fast as you can.

muscle-strength-2-jhm.gifMuscle Strengthener 2

Place your hand palm­-down on a table. Place your other hand on top of that hand, and lift up with the fingers of the hand on the bottom. You can lift the fingers all at once or one at a time.

finger-curls-jhm.gifFinger Curls

Keeping your wrist straight, extend and spread your fingers. Then make a loose fist, keeping your thumb on the outside of your fingers.

Publication Review By: John A. Flynn, M.D., and Carl A. Johnson, M.D.

Published: 20 Jun 2011

Last Modified: 16 Dec 2011