Written by the Phoenix Rehab hand therapy team.Clinically reviewed by Nigel Chua, Hand Therapist and Director, AHPC A1300362Z.Last reviewed 4 October 2026.
Rheumatoid arthritis is an inflammatory disease that often starts in the hands: swollen, stiff knuckles and wrists on both sides, worst in the morning. Your rheumatologist controls the disease with medicine. Hand therapy works on what the inflammation does to the hand: grip, stiffness, joint strain in daily tasks, and splints that rest a flaring joint or support a drifting one.
What rheumatoid arthritis in the hands looks like
- Swelling and tenderness at the knuckles (the MCP joints), the middle joints of the fingers and the wrists, usually on both hands.
- Morning stiffness that lasts more than an hour, easing as the day goes on.
- A weaker grip: jars, taps, car doors, carrying a bag with the fingers.
- Over years, without control of the disease, fingers can drift toward the little finger side, or bend into swan neck or boutonniere shapes.
Swollen, stiff knuckles on both hands are a reason to see a doctor, who decides on blood tests and referral. Early treatment by a rheumatologist matters.
Osteoarthritis or rheumatoid arthritis?
| Osteoarthritis | Rheumatoid arthritis | |
|---|---|---|
| Joints | The end finger joints, the middle joints and the base of the thumb | The knuckles, the middle joints and the wrists |
| Feel | Hard, bony bumps | Soft, puffy swelling |
| Morning stiffness | Usually under half an hour | Often over an hour |
| Read more | Finger arthritis · Thumb arthritis | This page |
What hand therapy does
- Exercise. A daily hand program of stretching and strengthening. In a large trial in people with rheumatoid arthritis, a tailored hand exercise program improved hand function compared with usual care.1
- Splints. A resting splint at night during a flare; a wrist splint for work; small ring splints for a finger that is starting to bend into a swan neck. Custom splints are made and fitted at the clinic. See custom hand splints.
- Joint protection. Ways to open, carry, lift and grip that put less strain on the knuckles: two hands instead of one, palms instead of fingers, larger handles.
- Work and daily tasks. Keyboard, cooking, childcare and caregiving, adjusted to the hand you have this month.
Medicines, steroid injections and blood tests are your rheumatologist’s decisions.
Hands that keep losing ground between reviews
Your blood tests have settled on the medicine. The hands are still stiff every morning, buttons take two tries, and you have stopped lifting the wok. The blood tests track the disease. They do not track the hand. Grip, pinch and finger range are a separate set of numbers, and they tell you whether the hand itself is holding its ground.
What we measure
- Grip and pinch. In kilograms, both hands.
- Range. How far each finger and the wrist bends and straightens.
- Function. The tasks that have become hard: jars, keys, buttons, carrying.
- Alignment. Early drift or bending of the fingers, so splints are fitted before it sets in.
Hand and wrist cases are managed by our hand therapy team.
When to see a doctor first
- Go to the emergency department now for one joint that is suddenly hot, red and very swollen with a fever, especially if you take medicines that lower immunity.
- See a doctor the same day for neck pain with new tingling or weakness in the hands or legs.
- See a doctor the same day if a finger suddenly cannot straighten on its own, often the ring or little finger. A tendon may have worn through and needs a hand surgeon.
- See a doctor soon for numbness and tingling in the thumb and fingers, which can be carpal tunnel syndrome, or a flare that is not settling.
Where are you with this right now?
1. The disease is controlled and the hands are working
If you manage your day and your grip has held, keep up your hand exercises. You do not need us for this, and we would rather say so.
2. The hands are slipping
The flare settled months ago, but the morning stiffness has not, and the jar lid now goes to someone else in the house. Grip and finger range on each hand can be measured, splinted where it helps, and trained.
WhatsApp us · Get Assessed & Treated · One 45-minute appointment, $230, nett, no GST.
3. You have had surgery, or you have a date
After a tendon repair, joint replacement or fusion in the hand, the stages are set with your hand surgeon. See hand therapy after surgery. All of it runs on the four stages of the Phoenix Recovery Protocol.
Related reading
Sources: 1. Lamb SE, Williamson EM, Heine PJ, et al. Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial. Lancet. 2015;385(9966):421-429.
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