Healthy Hands

Do you ever take a good look at your hands? As we age, our hands can begin to show the signs of all those years of service – holding, lifting, making, cleaning, trimming, touching, washing … the list goes on.

Degenerative hand problems are common in our later years, but there’s a lot we can do to minimise their impact and live more comfortably with them. Don’t leave your aches and pains untreated when help is available. It’s important for our independence and quality of life that we keep our hands functioning as well as possible for as long as possible.

In this article, we discuss common hand conditions and ideas for prevention, help and hand care. It’s never too late to invest in your hands’ health – and your positive future.

Common hand problems

So what are some of the common hand problems experienced by older people?

• Osteoarthritis – the most common form of arthritis, experienced as swollen, bony nodules on the finger joints and stiff, painful joints that restrict movement

• Dupuytren’s contracture – a tightening of the connective tissue (fascia) in the palms that pulls affected fingers to a bent position

• De Quervain’s tenosynovitis – a type of repetitive strain injury (RSI) often associated with repetitive or ergonomically stressful movements

• Gout – a warm, red and painful swelling of joints that often occurs quickly, causing sudden, intense pain in the joints

• Carpal tunnel syndrome (or CTS) – the compression of nerves from the forearm that causes pain, numbness and tingling in the hands and wrist

• Scaphoid fractures of the wrist – often acquired during a fall, and one of the most common wrist fractures

• Wrist ligament injuries – damage to the soft connective tissues, often cause by repetitive use or sudden impact, such as in a fall

Did you know …

… that each of your hands has 27 bones, 27 joints, 34 muscles and more than 100 ligaments and tendons?

That’s pretty complex engineering in one small package.

(Source: Australian Musculoskeletal Health Australia)

Hand therapists can help

What is a hand therapist? They are occupational therapists or physiotherapists who have undertaken specialised training in hand and upper limb health, conditions and rehabilitation. Hand therapists must be registered with the Australian Health Practitioner Regulation Agency (AHPRA) and accredited with the Australian Hand Therapy Association.

Emmeline Fooks, from Melbourne Hand Therapy at Blackburn, says that consultations and treatment programs are focused on what the patient wants to achieve.

‘We start at the beginning: what things is it causing problems with? And you hear about, “well, I can’t do my sewing” or “I can’t knit”. You hear about the impact on life … because everyone’s very different.

‘Then we will do a very thorough clinical examination – observing movement, palpating different joints, assessing severity of joint destruction through compression … doing a thorough assessment.’

The individualised treatment program could involve strategies like targeted exercise, soft tissue release and heat packs for pain control. Splints can stabilise joints, and maintaining or improving joint movement is important. The client’s progress is usually monitored over several months.

The most common conditions Emmeline sees in older patients are osteoarthritis, Dupuytren’s contracture and de Quervain’s. But for all patients, she emphasises the importance of good thumb stability, exercises to manage pain and improve function, and ‘lots of education’ to help patients manage their condition.

‘We educate people about the challenges of winter or first thing in the morning, when it’s colder – getting little pocket warmers to fit inside gloves or long sleeves, the benefits of gentle massage to generate a bit of heat as well,’ says Emmeline. ‘Heat is very therapeutic … muscles just relax and soften.’

To find a hand therapist near you, try the Australian Hand Therapy Association’s online directory.

Modern lifestyles affect hands

Emmeline points out that our modern lifestyles have changed what we do with our hands, so the demand on them is different now.

‘Historically, it’s new mums that would develop de Quervain’s … [now] we see it with lots of grandparents who are doing primary caregiving for babies. [And] we’re seeing a very active older population,’ she says.

‘People are attending the gym when 50 years ago, that age group weren’t doing that. There’s a lot of texting, being on iPads and computers. We’re probably writing less. People might be driving longer [and] probably more women are driving than 50 years ago.’

Treatments for hand conditions

In the past, older people have tended to put up with pain, restricted movement and stiffness in their hands because it was thought to be an inevitable part of growing older. Today, you can expect to live more comfortably.

If you’re experiencing pain and disruption to your daily life, seek help. There are lots of treatments and aids available now to increase your comfort, manage the pain and help you to keep functioning.

Here are some of the more common ones, but talk to your hand therapist, doctor or physiotherapist for advice on what will be most helpful and appropriate for you.

• Splints and gloves can help make painful joints more comfortable. They need to be well fitted, so speak to your hand therapist for advice.

• Medications are available for relieving chronic pain and the underlying problems, so consult your doctor without delay.

• Heat packs may help to ease pain and is great for relaxing muscles. Ask your doctor or therapist’s advice for your particular problem first.

• Anti-inflammatory creams may help, depending on your condition, but talk to your doctor before you try one.

Can you prevent hand problems?

Although degeneration does come with age, changing the way you do tasks can help to prevent hand problems developing or getting worse. Finding a better way to move your hands can reduce the force on the joints, alleviate inflammation and soft tissue strain, and help protect the joint surface.

• Use your body’s larger joints and muscles when you can – for example, holding things close to your body reduces the strain on your hands. Carrying bags on your forearms or over your shoulder shifts the load to stronger joints and muscles.

• Avoid gripping things tightly – consider replacing your taps with lever taps, and stock up on assistive gadgets like jar openers and easy-grip utensils. Your therapist will have suggestions.

• Avoid repetitive movements, such as typing or pruning the garden – if you must do these tasks, break them down into shorter sessions and take regular breaks along the way.

• Carry things with two hands instead of one – this distributes the weight evenly across both hands rather than loading up one.

• Reduce the effort – use assistive tools. Borrow a trolley when moving large items, buy an electric can opener for the kitchen, and look for easy-open packaging when choosing goods in shops.

• Relax your grip during longer activities – for example, if you’re writing, change or release your grip on the pen every 10 to 15 minutes to give your hands a rest.

• Do any exercises your doctor or therapist gives you – they’ll help to prevent the condition taking hold or getting worse.

Hand strength is important

Speaking of exercises, maintaining or improving hand strength is another positive hand care measure.

Hand strength exercises can help you keep a strong grip, which will support you continuing your daily activities and reduce your risk of a fall. They can also contribute to joint stability, which, Emmeline says, can help to reduce pain.

Here are some simple hand strengthening exercises you can try. (If you have a pre-existing injury or condition, check with your doctor first.) Repeat each one a few times or until you feel your hands tiring.

• Finger presses – put both hands together so your fingertips are touching but your palms are apart. Gently press the fingers together, then relax.

• Face washer wringing – wet a face washer, hold it in both hands, and twist it to wring out the water. Move your hands in opposite directions, then swap directions.

• Stress ball squeezes – hold a soft stress ball in your hand, squeeze it with all fingers and thumb, and hold for 30 to 60 seconds. After a few repetitions, swap the ball to the other hand.

• Rubber band stretches – slip a sturdy rubber band around all 4 fingers of one hand, then push your fingers apart, stretching the band. Relax your fingers. Remember to strengthen the other hand after a few repetitions.

Looking after your hands

Regardless of the current condition of your hands, being aware of them and giving them some regular care can help to minimise future problems.

• Practise good hand hygiene: wash regularly and dry the hands well.

• Keep your nails clean and trimmed – a manicurist can help here if you can’t manage them yourself.

• Inspect your hands regularly for any swelling of changes to the nails, skin, joints or direction of the fingers. Take note of any new aches and pains or different sensations you feel so you can discuss them with your doctor.

• Keep moving your hands as much as possible – it’s important for reducing stiffness and keeping your joints and muscles working.

Hands enable us to do most of our day-to-day activities, so it’s hard to overestimate the importance of hand health and care – and of seeking medical support. Therapist Emmeline agrees.

‘People say, “Oh, it’s just arthritis, there’s nothing you can do, is there?” Well, actually, yes, there is. There’s a lot we can do.’

For more information and help

Talk to your doctor, hand therapist, physiotherapist or occupational therapist about your symptoms and situation. You might be surprised what they can do to help your hard-working hands and make you much more comfortable!

Here are some great sources of information about healthy hands, common problems and practical hand care.

Arthritis Australia:

• ‘Hands and arthritis’ information sheet (PDF)

• Infoline: phone 1800 011 041

• state and territory associations (except Victoria)

• Australian Hand Therapy Association website

• Musculoskeletal Health Australia Hand conditions and tips for joint protection webpage

• The Arthritis Movement Joint protection for the hands webpage

Disclaimer: The information provided on this website is not a substitute for individual health advice from a doctor or dietitian.

Emmeline Fooks trained in occupational therapy before specialising in hand and upper limb rehabilitation. She enjoys lecturing and presenting on hand therapy to surgeons, GPs and graduating therapists and is also a qualified yoga instructor.