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rheumatoid arthritis hand exerci
General Education

Rheumatoid Arthritis Hand Exercises

November 30, 2021
35 min read
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Do you want to improve your hand strength and flexibility?

Learn the classic hand stretches and strengthening exercises that may help prevent or reduce hand deformities for rheumatoid arthritis (RA) (along with comprehensive medical care)! 

In this video, Arthritis Life founder and RA patient Cheryl Crow and occupational therapist Corinne McLees of Mobile OT Wellness Group show you:

  • Exercises for the wrist, fingers and thumbs that are particularly helpful for people with rheumatoid arthritis
  • Stretches for the wrist, fingers and thumbs. 
  • Answer frequently asked questions about common deformities associated with rheumatoid arthritis including ulnar drift and swan neck deformity.

Video breakdown:

  • Intro to Occupational Therapy for arthritis & fundamentals of hand exercises (0:00-6:45)
  • Exploration of some of the typical deformities or joint changes that occur with rheumatoid arthritis (e.g. ulnar drift), including an explanation and demonstration of what’s going on currently with Cheryl’s hands (6:50-12:00)
  • Exercises typically recommended for people with rheumatoid arthritis to help maintain or regain range of motion:
    • Wrist flexion & extension (bending) (12:24)
    • Wrist side to side (radial & ulnar deviation) (13:12)
    • Finger flexion and extension: Making a fist and opening fingers up, “Jazz Hands” (14:42)
    • Hypermobility – brief discussion (15:45)
    • Thumb opposition for each finger (17:00)
      • Chip clip trick for when you have muscle pain at base of the thumb (“thumb adductor”): (17:35)
      • Tips for starting a new stretching habit (or any habit): (18:38)
    • Hand anatomy basics: Brief exploration of muscles, tendons and ligaments, and where the muscles that move the hand originate (19:03)
    • Tendon gliding exercises: (21:50)
    • Brief exploration of Ulnar drift, a deformity associated with rheumatoid arthritis (23:40)
    • Exercises that may counteract ulnar drift (25:47)
      • Practical ways to avoid ulnar drift during everyday activities (27:10)
    • More exercises to counteract ulnar drift (28:34)
    • Thumb stability exercises that can help osteoarthritis and rheumatoid arthritis thumb pain (30:00)
    • Stretches for “swan neck deformity” (33:25)
    • Concluding thoughts (34:33)

Medical disclaimer: 

All content found on Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Links mentioned in this post:

  • ABCs of OT post: ulnar drift (link to)
  • Yoga – when are you measuring flexibility versus joint instability? (to link to article)
  • Article to learn more about ulnar drift

Cheryl’s Arthritis Life website and socials: 

Corinne’s Mobile OT Wellness Group website & Socials:

Arthritis Life Program Links

Join the waitlist for Rheum to THRIVE,  6-month education and support program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. The next group starts in Spring 2022!

Rheumatoid Arthritis Roadmap, a self-paced online course Cheryl created that teaches you how to confidently manage your physical, social and emotional life with rheumatoid arthritis. 

Full Video Transcript

Cheryl:

Hi everyone. This is Cheryl Crow. I am a patient with rheumatoid arthritis. And I’m also an occupational therapist and I run the patient education and empowerment company, Arthritis Life. And today I have Corinne with me. Do you want to introduce yourself?

Corrine:

Yes. My name is Corrine. I’m an occupational therapist in Virginia specialized in hand therapy, and I’m the owner of Mobile OT and Wellness group. I do in person and virtual visits. I go into people’s home and bring basically outpatient hand therapy into the home. That’s

Cheryl:

That’s so cool. That’s really exciting. And this is my hand. We have this very creative idea today. We’re going to be talking about different kinds of hand stretches and exercises to do if you have rheumatoid arthritis. But very quickly, first, I just wanted to say if you’re not sure, what is an occupational therapist versus a physical therapist? When it comes to hand therapy and hand stretches, there is a lot of overlap, not going to lie. A physical therapist might tell you some very similar stretches to an occupational therapist.

Cheryl:

But our goal at the end of the day, I like to say if I could rename occupational therapy, it would be life skills therapy. Because our goal is always about helping you function in your daily life. So though we’re talking about this hand by itself today, in OT, in a real session, we’d be talking about, “Okay. How does your hand hold the computer mouse? Is there a different way to do it?” I actually have a… This is my travel mouse, but at my regular work setting, I have my upright one. So you’re looking at your actual daily activities. How do you hold a knife? How do you do your makeup? Really drilling down to this specifics of your life, and that’s kind of what separates occupational therapy.

Cheryl:

But today that we are just going to be going over some general exercises. But as a medical disclaimer, nothing that we say today is going to supersede or take precedence over what your individual health team recommends for you. This is just a demonstration of some of the stretches on a real patient with rheumatoid arthritis. I’m going to put my left hand so you could see my left hand as well. What does it look like on a real patient? Because I don’t know about you guys, but when I see things like demonstrations, I always kind of want to know what would it look like on me? Did you want to add anything Corrine about that disclaimer or anything else?

Corrine:

Well, yes I would love to. Exercise has actually been found to be effective in decreasing arthritis related pain, improving your blood flow, and improving your actual cartilage, which is really beneficial, especially for rheumatoid arthritis. However, your exercise program, as Cheryl said, is dependent on your individual needs and your hands. For example, if you had an unstable wrist, doing a lot of repetitive wrist range of motion exercises might actually lead to rupturing your extensor tendons. Or, if you have an unstable thumb, some of the exercises might cause more of a thumb deformity.

Corrine:

So it’s important to always talk with your doctor or talk with your therapist before doing any exercises, and avoiding painful motion. Joint instability rather than actual weakness might actually be more problematic during activities. So if your hand is collapsing, it might not even matter that you’re weak, if your hand is collapsing. So sometimes, if you do have an unstable hand, an unstable wrist, if your thumb is often feeling like it needs to locate, figuring out how to give it stability before even exercising it can be helpful. So figuring out a good splint, or a wrist wrap to wear in conjunction with doing the exercises while it’s positioning you correctly, so that you can strengthen yourself in the best motion possible.

Cheryl:

Yeah. And just to drill down even further, when you say instability, can you describe… How do I know if I have instability as a patient?

Corrine:

That’s a great question. It just might feel like it’s weak. It might, if you’re trying to hold something, you might notice that your joint is collapsing. And by that I can actually show you on my thumb. I have joint thumb instability. So my thumb likes to go… hyper extending. If your joint is doing something that it looks like it shouldn’t be doing.

Cheryl:

I see. Would hyper mobility be an example of that? Yeah. Okay.

Corrine:

Yeah, definitely. Yeah. And for the wrist, if your wrist is unstable, you might feel clunking, it might be painful popping. That’s a sign of joint instability. So if you have any of that, it’s really good to talk with your doctor and do exercises under the guidance of a therapist.

Cheryl:

Yeah. In the context, and we could do a different video on this where it’s simulating a real session. Corrine would measure all of these tiny little angles. In an initial evaluation you’d measure the angles, you’d measure my strength, my grip strength, pinch strength, for all these different tiny muscles in the hand. So the hand is extremely complex, right?

Corrine:

Yeah. It really is. And everything is just very… It depends on the person. But I’m really happy today to go over just some basic gentle range of motion exercises that you can do, especially if your hands feel stiff. If you do feel stiff and you’re not in an inflamed state, heat is a good idea to do before doing your exercises, just so that it can improve your joint range of motion. So I always recommend putting some heat on before doing it, especially if you’re not inflamed.

Cheryl:

Yeah. And heat versus cold is a interesting debate in the patient community. I think that a lot of people find that they have a positive really with heat. Right? Because it feels warm and comforting. I do find personally, if I am having a hot joint flare up, then cold is actually more relieving than heat. But if I’m stiff my rule of thumb is if I’m stiff, I’ll do heat. But if my joints are hot and inflamed I’ll do cold. But again, get the guidance from your providers.

Corrine:

Yeah, yeah, absolutely. And after doing some exercises, sometimes you might not have felt inflamed, but then if you do feel inflamed afterwards, you could always put cold on afterwards.

Cheryl:

Yeah. And just something to show, I’m just going to put my hands up here so you can kind of see, this is my right hand and this is my left. I have had rheumatoid arthritis for 19 years now. I’m trying, I can’t really put my hands together at the same time. I’m going to knock my tripod. Oh, there we go. My tripod is a little precarious. But one of the things that is a diagnostic aspect of rheumatoid arthritis initially is they typically look to see if it’s bilateral. If you have just one little finger that’s hurting, might be osteoarthritis or an injury. If you have both sides it tends to be more of a sign of something more systemic. But from the very beginning for me, so again, it’s been 19 years, my right side has been more painful than my left.

Cheryl:

And we could do a whole other thing of just analyzing my hands. But certainly if I had been… I was diagnosed in 2003 and put immediately on aggressive drug therapy for rheumatoid arthritis. If I had been diagnosed two decades earlier, the typical progression would be much more substantial, deformities or joint differences that I have. But that said, this is not… I wish I could get my sister to do a video so we can kind of have like the closest relative. This, my range of motion, and see how my little pinky kind of goes in. This is not normal. The disease is not completely in remission. Oh, here, can I slide? I can’t really slide them in. But did you, do you want to point out anything about my rheumatoid arthritis? [crosstalk 00:08:28]-

Corrine:

I definitely feel like… I was telling you. I think maybe it does look like your fingers are trying to drift a little bit on that side. It looks like that tendency is there, more so than left? Are you right handed?

Cheryl:

I am right handed.

Corrine:

Yeah. I’ve noticed that a lot. A lot of my patients that have rheumatoid arthritis, their dominant hand will progress more quickly than their other one. Yeah.

Cheryl:

And from the very beginning, it’s been worse on my right. This is the first joint I thought I had sprained before I knew I had rheumatoid arthritis. I said, I have a sprained finger.

Corrine:

Oh man.

Cheryl:

Yeah.

Corrine:

And your right hand does look a little more swollen too.

Cheryl:

Yeah. Right now I am not in what we would call medicated remission. I have mild to moderate disease activity. And at this point it’s hard to know. I’ll tell people, even though I’m an occupational therapist, and I’m a patient educator, I don’t truly know, at 40 years old after this for 19 years, what should my baseline be?

Corrine:

Right. I know.

Cheryl:

What am I trying to achieve?

Corrine:

That’s so hard because it’s literally been half your life.

Cheryl:

Yeah. And I don’t know, to me it comes back to… And this is such an OT way of looking at it, but can I do the essential functions of my life? Can I clip the little annoying clip on my dog’s collar when I need to take him out? Can I cook for myself? Can I do the basic functions? Can I put my hair in a ponytail? If I can do those things without substantial pain and getting in the way, then I’m okay with that to some degree. But anyway, it’s all complex,

Corrine:

Yeah. Yeah. No, I totally agree with you though. As an OT.

Cheryl:

Yeah.

Corrine:

I also want to point out one more thing I’m seeing, and this is common with rheumatoid arthritis, these MCP joints on your hands, especially that right index finger one, they’re just a little more swollen, a little bit more prominent.

Cheryl:

Yes. I am very small frame. You can see how tiny my wrist is.

Corrine:

Right.

Cheryl:

I don’t want to be like, “I’m skinny. Look at me.” But I’m saying this should not be that thick.

Corrine:

It shouldn’t look like that. Yours should look more like this.

Cheryl:

We could even do like a side by…

Corrine:

Yeah.

Cheryl:

Is it your left hand or your right? Oh there we go.

Corrine:

That’s my right hand.

Cheryl:

Oh. Oh, okay.

Corrine:

Isn’t that funny? That’s weird that [crosstalk 00:10:45].

Cheryl:

It’s hard, because it’s trying to focus on my face.

Corrine:

Okay. I can definitely, yeah. Tell the differences [inaudible 00:10:56] across yours.

Cheryl:

And I know if you were my OT, and we were in an in person session, or even a rheumatologist as part of my every three month, check-in, she palpates. If my RA was in remission, I would probably be doing virtual appointments. But since it’s not, she palpates, which means she presses on it in different angles and she can identify, and you could identify, really the degree of swelling as well. And I remember asking her once I said, “In a normal person who doesn’t have RA, does it not hurt at all? If you press…” Because to me, it’s unthinkable that if you pressed on your joint, it wouldn’t hurt at all.

Corrine:

Oh wow.

Cheryl:

It’s not like I’m an excruciating pain.

Corrine:

Sure.

Cheryl:

It’s not like I’m, [inaudible 00:11:38].

Corrine:

But you just maybe thought your whole life, it should hurt everybody to be pressed on your joints.

Cheryl:

I mean, just you press it. [crosstalk 00:11:46].

Corrine:

Yeah. That doesn’t hurt me. No.

Cheryl:

Whereas if you press like this, that doesn’t hurt.

Corrine:

Yeah. Right. Right.

Cheryl:

A joint shouldn’t hurt.

Corrine:

It feels like pressure. Yeah. It shouldn’t. But…

Cheryl:

But it gets to the point where we don’t know if you’ve lived with [crosstalk 00:11:58]-

Corrine:

Yeah. What’s normal? Yeah, exactly.

Cheryl:

Exactly.

Corrine:

Yes, definitely. Well, I think that was a good intro and I’m happy to go over some exercises that I would typically recommend just for somebody with RA who is looking to maintain, or even regain a little bit of motion.

Cheryl:

Yes.

Corrine:

So the first one is just practicing, bending your wrists. So if you would want to put your hand like this.

Cheryl:

Okay.

Corrine:

And gently come forward. And if you need to stabilize like right here.

Cheryl:

Oh okay.

Corrine:

If that is on your forearm still coming forward.

Cheryl:

Oh yeah. So you’re not going like this.

Corrine:

Yeah. So your elbow’s not going everywhere.

Cheryl:

Yeah.

Corrine:

Yeah. So usually I would recommend going through 10 repetitions or so. I wasn’t counting. But if you want to count you can.

Cheryl:

I think I’m on six, my hands have their own stage here.

Corrine:

I know it’s [crosstalk 00:12:55]-

Cheryl:

Should my thumb just be relaxed?

Corrine:

Yeah. Just a relaxed thumb. Whatever is comfortable to you. If it’s relaxed like this, or if it’s more like this.

Cheryl:

Yeah.

Corrine:

Yeah. Whatever’s comfortable.

Cheryl:

Okay. And that was 10.

Corrine:

Okay, perfect. So our wrists move forward and backwards. They also move side to side. So again, I would recommend stabilizing like this, and then trying to move.

Cheryl:

Yeah.

Corrine:

Just gently. You want to avoid any painful range of motion, active range of motion, which is what this is, versus a passive stretch is a great way to not overdo it.

Cheryl:

So true. So it’s not a case like no pain, no gain.

Corrine:

Right. Absolutely. If it hurts, then stop. Your body is talking to you.

Cheryl:

Yeah. I just feel a little tension. Would you say that? Would you want to go to where you start feeling a little stretch or tension?

Corrine:

Yeah. Yeah. Like a mild, a two out of 10 tension. Two to four. It depends on, everything’s so subjective. It depends on your pain scale, but I would say-

Cheryl:

That’s so true. And I think that a lot of us have talked about in the RA community, there’s a different pain scale for all the different kinds of pain. Stabbing pain, I might be zero on stabbing pain, but I might be a six on stiffness.

Corrine:

Right.

Cheryl:

Which is kind of like pain, but it’s not hot pain. It’s just… Yeah.

Corrine:

Absolutely. Everything is so dependent. Yep. Okay. How does your wrist feel? Oh go ahead.

Cheryl:

It feels good. Yeah. I’m sorry. I have a little scratched there. Don’t worry. I’m okay. I don’t even know how I got that.

Corrine:

Looks like you have a cat.

Cheryl:

I know. I do. But I don’t remember them scratching me, anyway.

Corrine:

Oh, okay. Well, so the next one is just gently making a fist and then opening your hand up. So I don’t know if it’s easier to be up here. If you do it up here-

Cheryl:

Okay. Oh here, let’s do this.

Corrine:

Yeah. There you go.

Cheryl:

Two hands at once.

Corrine:

Yeah. If you do it up here, then it’s actually going to help push some swelling out. So that might be a case for doing it up here. Yeah.

Cheryl:

I like to call this jazz hands.

Corrine:

Yeah.

Cheryl:

And it does. It’s interesting. I can feel, especially in my right, I feel a little bit of resistance as I go down, not pain.

Corrine:

Interesting.

Cheryl:

Just a little bit of that tightness is the word I would say.

Corrine:

Tightness almost, maybe because of the swelling? Does it feel like-

Cheryl:

Probably. Yeah. But then if I could feel it kind of release a bit as I do this. So…

Corrine:

As you do it. Yeah. And I mean, sometimes even putting your arm up taller, and actually making a fist and straightening, it can really also help decrease swelling.

Cheryl:

Oh, that’s awesome. Okay. [crosstalk 00:15:43]-

Corrine:

But then I don’t know if you have shoulder or elbow pain. I see your elbows or hypermobile.

Cheryl:

Oh yeah.

Corrine:

Wow.

Cheryl:

It’s interesting. I think, yes, you see it.

Corrine:

Yes. Yeah. Side note. I have heard of rheumatoid arthritis often being coupled with like hypermobile Ehlers-Danlos syndrome, or other systemic things that cause hyper mobility.

Cheryl:

Yeah. I have too. I have too. And I don’t know what the direct, if there’s a causal or correlation.

Corrine:

Right. I don’t know either.

Cheryl:

… Underlying thing that’s causing both of them.

Corrine:

Right.

Cheryl:

Kind of interesting. But it’s good to know, I know that there was this article… I’ll put a link to it in the show notes, the description of the video. There’s an article about stretching, if you’re doing yoga, which we know yoga’s not just stretching. But if you’re doing yoga as a stretching exercise that sometimes what you’re measuring is not someone’s like flexibility. You’re measuring how hypermobile.

Corrine:

Yeah. That’s true. Right.

Cheryl:

It’s actually not helpful for your body to be hypermobile, extra mobile beyond the normal joint range of motion.

Corrine:

Yeah. That’s true. Because then that can create unstable joints.

Cheryl:

Right. Right.

Corrine:

[crosstalk 00:16:59] hands. Yeah. So the next one is thumb opposition to each finger.

Cheryl:

Should I do that up here?

Corrine:

I don’t know if you want to do it up there?

Cheryl:

Yeah. It’s probably easier to just… I got excited about my third screen.

Corrine:

It is exciting, but I think there’s a couple coming up that you can do your third screen.

Cheryl:

Yeah. And it’s interesting. I don’t know if it’s because we’ve just been doing these. But I can feel just a little bit of… This is my little poofy joint right now, but there’s a little bit of…

Corrine:

Do you ever feel tightness in this muscle right here?

Cheryl:

I don’t know. But what if I did? What would I do?

Corrine:

If you did, great question. You might take… I have a chip clip and put it right here. Have you heard of this?

Cheryl:

No.

Corrine:

Oh, okay. It releases the muscle. Yeah. So you want to make sure that it’s not like this, because that’s just your skin. But that it’s actually down into that thumb adductor muscle. That’s the muscle that pulls your thumb in. And so if you have a tight thumb, like you mentioned, your thumb was tight earlier, before we started the show. And it could be because potentially this muscle right here is tight. If this muscle’s tight, it’s going to hold your thumb into the hand more. So I would recommend releasing that muscle for two to three minutes with the appropriately tensioned chip clip.

Cheryl:

Okay. Perfect.

Corrine:

And then that can also help it just feel a little bit looser before doing your thumb exercises.

Cheryl:

Oh, that’s so fun. Yeah. And this is something you could be doing… Let’s say… I always like to think when I’m trying a new habit about habit stacking. So let’s say I’m brushing my teeth with my right hand. I could be doing this with my left hand in the morning. You know, trying to think about where-

Corrine:

Yeah. Right. To add it in.

Cheryl:

… Putting toast in the toaster. Just kind of do some of these.

Corrine:

Definitely. Yeah. Especially if you’re stiff in the morning. I know lot of people that wake up stiff.

Cheryl:

Yes.

Corrine:

Or in a hot shower, just do your [crosstalk 00:18:54] exercises.

Cheryl:

Oh, that’s so great. Yeah. I love that.

Corrine:

So the next one is, have you heard of tendon gliding exercises?

Cheryl:

Yes, but I think a lot of patients haven’t so.

Corrine:

Okay, cool. So tendon gliding exercises, they take your fingers through basically all of the motions that are going to stretch your tendons and ligaments out in different ways. Which is important because sometimes just closing and opening your hand doesn’t necessarily get all of the intrinsic muscles of your hands, or all of the tendons. So we call them tendon glides because it just glides your tendons in all of different motions and lengths.

Cheryl:

Oh, and just a quick thing. So tendons are at the end of the muscle and they attach the muscle to the bone and ligaments attach bone to bone, right?

Corrine:

Yes. Thank you. That’s right. Yep. Yep. Very true.

Cheryl:

So what is important, and I think we’ll someday do a different video on this, but really delving into the anatomy of the hand.

Corrine:

I would love to do that. Yes.

Cheryl:

Yeah. Because I think a lot of times we just think, or I thought before I went to OT school, it’s like joint, joint, probably a few muscles in there, joint, joint, probably a few, but it’s so complex.

Corrine:

It’s so complex. A lot of people think all of the muscles that move your hand are in your hand, and that’s really not the case. Most of the muscles that move your hand are actually down here. They’re muscle bellies in your forearm. And then the tendons go from the muscles, into your fingers and attach in your fingers. You can pull it.

Cheryl:

If you just put one hand on here and then you can feel, oh my gosh.

Corrine:

Or if you go on the back and open.

Cheryl:

Yeah. But just put your hand out. So much [crosstalk 00:20:34]. Ha. But no it’s so true. We actually had a cadaver lab at my OT program. I don’t know if you did.

Corrine:

We did too.

Cheryl:

It was really, I mean, it was a really good learning experience. I remember kind of mechanically pulling on the tendons and seeing what was [crosstalk 00:20:51].

Corrine:

It’s amazing. Yeah.

Cheryl:

It was like an aha moment for me. So anyway, point being, we know if you’re a patient with rheumatoid arthritis, you know that you have a joint condition. And that the joint is like the space in between the two bones. But the muscles outside of that are also having tendons attached to those bones and there’s ligaments attached to them. So sometimes what we think is, oh, it’s a joint issue because it’s our rheumatoid arthritis. It might actually be that the tendons… I mean, I guess it depends on where do you decide to define the joints? Sorry. The joint capsule is that space, but the joint itself can be conceptualized to include all those tendons and everything. So I think it can get confusing to know what is causing my pain? That’s-

Corrine:

Absolutely. What is causing my pain? What’s causing my stiffness?

Cheryl:

Yes.

Corrine:

Okay.

Cheryl:

Yeah.

Corrine:

Definitely.

Cheryl:

Sorry. I just [inaudible 00:21:44].

Corrine:

No. It’s really helpful. You’re a really great educator. So tending glides, normally we start up tall, then come down into a hook and then bring it. [crosstalk 00:21:56]-

Cheryl:

Is it okay to do it on a [crosstalk 00:21:59] minimized-

Corrine:

That’s perfect. Yep.

Cheryl:

Oh I could… Your fingers are really flexible, or is that normal?

Corrine:

Yes. They are. No, it’s not. That’s not normal. I’m very, very weird. Yeah.

Cheryl:

Oh.

Corrine:

Yeah. I know my thumbs hurt often.

Cheryl:

Oh.

Corrine:

No it’s okay. So we go from-

Cheryl:

You have lived experience. So…

Corrine:

Yes I do. Just like you do. So hook and then full fist, after the full fist we bring it to a tabletop.

Cheryl:

Okay.

Corrine:

And then we can come back. Oh no, sorry. Tabletop flat fist. So if you were to try to one hand and clap, that’s what the flat fist is.

Cheryl:

Oh yeah. I can feel that it’s doing different stuff. I’m trying to coordinate and watch this at the same time. It’s like trying to pat your head and…

Corrine:

So that first one was rough. Let’s do that again.

Cheryl:

Okay. Yeah.

Corrine:

Straight up tall, hook, full fist, tabletop, one-handed clap.

Cheryl:

I’ve never heard that the one-handed clap. I love that.

Corrine:

I feel like flat fist is just hard for people to sort of conceptualize.

Cheryl:

Yeah.

Corrine:

Hook, fist, table top. So we’re yeah, really trying to get that right angle and then…

Cheryl:

Oh, that’s as good as I can… Oh sorry. This hand.

Corrine:

No, you’re good. And then one-handed clap. And you know, your thumb can just sort of stay out of the way, it’s okay.

Cheryl:

Yeah.

Corrine:

It can be hard to figure out what to do with that thumb during these, but mine just normally stays sort of in line with the hand comfortably out of the way.

Cheryl:

I’m sorry. I’m interrupting ourselves.

Corrine:

No, you’re good.

Cheryl:

Can you put your fingers in your… What does it look like when you curl your fingers in? So I remember when I was a hand model for the medical school.

Corrine:

Oh cool. Very cool.

Cheryl:

They had to get patients come in. I remember them saying that they could tell my deformity a little bit just from looking at this because this one’s not totally straight.

Corrine:

I do see it a little bit. I do. And your hands, when you make a fist, they’re supposed to sort of drive this way. You know?

Cheryl:

Oh, that’s right. Yeah, yeah. Yeah.

Corrine:

And so with the ulnar drift, oftentimes that pushes the fingers more…

Cheryl:

Mm-hmm (affirmative).

Corrine:

I can’t even really do it but almost more in line with the hand, straight down.

Cheryl:

When we say ulnar drift, ulnar is the pinky side. So the deformity that happens with rheumatoid arthritis is over time if it’s not controlled, your fingers curl and the knuckles drift towards that pinky side. Yeah. Mines very small but [crosstalk 00:24:46]-

Corrine:

Yeah, it actually starts at the wrist.

Cheryl:

[crosstalk 00:24:49].

Corrine:

Yeah. Usually it does start at the wrist. It will do sort of a zigzag, like your wrist will sort of go radially, or towards the thumb. And then your metacarpals, or the bones right here will shift that way, causing your fingers to shift that way. So I actually have a client with pretty significant ulnar drift in just her dominant hand. Her other hand does not have it. And she’s amazing. She’s a weight lifter. So she really wants to focus on the specific muscles that are opposite of the ulnar drift. And she wanted to know ways to almost try to counteract it. Not that there’s… We don’t know that that’s a possibility, but we’ve been exploring that.

Corrine:

And so with ulnar drift, you want to avoid strengthening or moving in this direction because we’re already over there. We need to come back this way. So for patients with ulnar drift, one of the first things that you can try is in a gravity removed plane, which just means we’re taking gravity out of the equation to make the movement easier. You can just put your hand on the table. And so if your hands are over here with the ulnar drift, you can try to bring each finger individually back in line. And with her because she has such significant ulnar drift, we actually discovered that putting Vaseline or lotion on the table is a way… Because her fingers don’t, not all of them will even move in this direction. Although we’ve gotten the ring now, but the ring was not moving. But with the lotion added to it, we got it.

Cheryl:

Oh, fascinating.

Corrine:

Mm-hmm (affirmative). Yeah. So just trying to work those fingers, just active motion back to the center.

Cheryl:

Nice. That’s great. And I know that a lot of when I posted for my ABCs of OT post for OT month. For U, it was ulnar drift.

Corrine:

Ulnar drift. Yeah.

Cheryl:

A lot of people didn’t even know there was a name for it. I just call it pinky drift sometimes.

Corrine:

Okay. Yes.

Cheryl:

It’s another reason I actually demonstrated the wrong way earlier, but if you’re holding, let’s say, holding your water bottle, gravity is constantly pulling down.

Corrine:

It is.

Cheryl:

[inaudible 00:27:19] So you can try to do things like maybe holding it like this, or two hands kind of like this, or with a coffee mug instead of holding it with… I don’t have one right next to me… Holding things with a handle.

Corrine:

A handle.

Cheryl:

You can hold it like with your hands like this. So that trying to avoid that position, it’s called the position of deformity. Any position, whether it’s not necessarily, you’re just doing this, when you’re just putting your hands up. It’s holding things. It’s more subtle. You’re like, “Oh yeah.”

Corrine:

Because of gravity, yeah.

Cheryl:

Or guess what? Your cell phone.

Corrine:

Yeah, for sure.

Cheryl:

Big one. How do we normally hold our cell phones?

Corrine:

Right.

Cheryl:

Holy [inaudible 00:28:00]-

Corrine:

Do you usually recommend like pop grips?

Cheryl:

I like a tripod.

Corrine:

Oh okay.

Cheryl:

Probably because that bypasses the hand altogether, but I know a lot of patients have told me that they like it. I don’t like that. Because it still puts pressure for me on my… I feel it on my knuckles.

Corrine:

Extensors? Yeah. Over your knuckles. Yeah.

Cheryl:

Yeah. So but definitely do what works for you. Many patients are able to tolerate it. Also because I do much videoing. I don’t want [crosstalk 00:28:26]

Corrine:

Yeah. You do a lot more.

Cheryl:

Because then it can’t go in my tripod.

Corrine:

Yeah. Yeah. For sure. So you know, if you have ulnar drift and you’ve mastered that tabletop motion of getting your fingers back in line, you could try… I don’t know how you want to demonstrate this, but I can show you this way. So you can try, like for example, hanging your hand over a table, which this is not a good demonstration. But if this hand were a table, you could try to get gravity back in. Right. So if we are trying to move them back up this way, then we’re resisting gravity now, and it’s a little bit more difficult to do that motion.

Cheryl:

Oh yeah. It is.

Corrine:

Against gravity. But once you’ve mastered that tabletop one.

Cheryl:

It’s harder.

Corrine:

Yeah. It is harder. Then you could try that. It’s hard.

Cheryl:

It’s hard to get… Because certain of the flexors and extensors, they go to both the pinky and the rings, so sometimes it can be hard to move just the rings independently. You’re like,”Oh I want to come over. Nope. I want… Nope. Just…”

Corrine:

Yes definitely. A way that actually you could add strength to that is like a rubber band would be the final way to strengthen it. So…

Cheryl:

Whoo, next level.

Corrine:

I know. It is really next level. And it’s really hard for even me to do, but we’ve explored that as well.

Cheryl:

Well that is such a beautiful demonstration of how in the process of therapy, you kind of become, you upgrade the challenge over time. So-

Corrine:

Right. You do. Yeah, absolutely. Definitely. So usually with osteoarthritis, this joint right here tends to be isolated, but it’s often common with rheumatoid arthritis as well. It’s like obviously other joints involved. But if you have arthritis in your thumb, that can cause this instability or like a deformity when you’re trying to do things. So what’s important to do if you have arthritis or if you have an unstable or painful thumb is to try to strengthen the muscles that are on the thumb. So trying to lift your index finger away from your hand, and it doesn’t really matter the position of your index finger. If it’s more comfortable, completely straight, or if you wanted to just have a curve.

Cheryl:

Yeah. That’s okay. That’s fine.

Corrine:

Just your index finger.

Cheryl:

Okay.

Corrine:

You should notice that muscle right here [crosstalk 00:31:08].

Cheryl:

Oh yeah.

Corrine:

It gets a little beefy. That’s your first dorsal interosseius muscle. And that’s a muscle that is often weak in patients with arthritis, but that’s one that really does stabilize. It comes down here, and it attaches right here, and it helps bring some stability to that first joint of your thumb.

Cheryl:

If you look really closely, you can see it moving.

Corrine:

Yeah, mm-hmm (affirmative) I do see it.

Cheryl:

There you go. That’s what’s fun is feeling it. It’s called palpating, if you feel the muscle, you can know that you’re…

Corrine:

Yeah. So 10 reps of that, and then the other muscle that helps to stabilize the thumb, is this one right here.

Cheryl:

Oh yes.

Corrine:

Yeah. And so trying to make a C…

Cheryl:

Mm-hmm (affirmative).

Corrine:

Which is really hard for me to do because of my thumb issues that we’ve talked about.

Cheryl:

Yeah.

Corrine:

What I have to do is almost try to create a bend right here.

Cheryl:

Oh. Okay. Sorry.

Corrine:

Because mine wants to collapse. So if you see…

Cheryl:

Well and I also injured this joint swing dancing. So there we go. I’ll try to do like that. Okay.

Corrine:

Like you’re going to hold a coffee mug.

Cheryl:

Okay. Yeah. Yep.

Corrine:

A cup. Yep. So you could do 10 reps of this, but I often recommend just also trying to do a sustained hold of the C in the correct form.

Cheryl:

Oh okay.

Corrine:

So…

Cheryl:

You should feel it here? That meaty part?

Corrine:

Like right here. Not so much here.

Cheryl:

Oh, here. Oh, okay. Outside.

Corrine:

Right here on the outside like that. Yep.

Cheryl:

Oh yeah. Oh, okay. I do feel it there now.

Corrine:

Right there. And you can probably yeah, feel it contract when you do that.

Cheryl:

Yeah. Oh oops. And my other fingers want to help. Yeah. I feel like a Muppet for some reason. Sorry.

Corrine:

That’s funny.

Cheryl:

Whatever makes it easy because I used to work in pediatrics, so I’m used to making everything into animals.

Corrine:

The kid stuff.

Corrine:

Yeah. And then there’s one more stretch that you can do if you notice that your fingers are having the beginnings of what we call swan neck deformity.

Cheryl:

Oh yeah.

Corrine:

Which just sort of means that this middle joint in any of your fingers is almost hyper extending like that. And then this one is flexing. So if your fingers tend to go like this, right.

Cheryl:

Mm-hmm (affirmative). Mm-hmm (affirmative).

Corrine:

A really good stretch for swan neck deformity, especially in the early stages of it is this.

Cheryl:

So you want the opposite direction [crosstalk 00:33:49].

Corrine:

Right. We’re sort of counteracting that. We’re stretching the intrinsics of the hand. And of course I’m hypermobile. So mine go way back. I’m doing all of them together, but you could also just of individually do it. And you’d want to hold for 10 or 15 seconds before switching onto the next finger. Again, you don’t want to overstretch, especially with passive range of motion, it can be hard to tell.

Cheryl:

Oh yeah.

Corrine:

So I would recommend just sort of starting small and then maybe slowly inching it back a little bit more. Do you have any questions?

Cheryl:

No, I think anyone who’s watching, who has questions definitely put them in the comments because we love to hear from people. What burning questions I have? Again, if anything’s hurting while you’re doing these, stop and get some guidance. In the United States, many health insurance plans do cover occupational therapy, or being seen by a hand therapist or hand specialist. And unfortunately I think because the drug therapies, I mean I’m evidence of the fact that the drug therapies have gotten so much better for rheumatoid arthritis. But one of the downsides of that is that sometimes people aren’t referring patients to occupational therapy as much.

Corrine:

Oh gotcha. Yeah.

Cheryl:

Because they think, “Oh, well they don’t need it because they’re going to do well on the medications.” Which it could be the case, but it could not. And I wish if I could have done something differently, I would’ve gotten some help from an occupational therapist earlier because at least I would’ve known how to prevent things and to use these range of motion, and stretching, and strengthening exercises that’s just helpful overall for your joint-

Corrine:

It is.

Cheryl:

… stability, joint strength and everything. So because if you have rheumatoid arthritis, even if you’re doing well with your current therapies, you’re still more susceptible to developing osteoarthritis later and everything. So…

Corrine:

Yeah, absolutely.

Cheryl:

Yeah.

Corrine:

Yes.

Cheryl:

Yeah.

Corrine:

It’s been a pleasure. I’ve loved it.

Cheryl:

It’s so much fun. Thank you. And make sure to follow Corrine at Mobile OT and Wellness group.

Corrine:

Thank you. And all of my friends follow Cheryl, please. She’s amazing.

Cheryl:

Yes.

Corrine:

[crosstalk 00:36:09] of knowledge.

Cheryl:

We love sharing our knowledge and entertaining and non traditional ways. Yay.

Corrine:

Yes. Yay.

Cheryl:

Okay. Bye bye for now.

Corrine:

Bye.