MSK Occupational Therapy Hand Therapy

You have been referred to the NHFT Musculoskeletal (MSK) Hand Therapy service by your healthcare professional for support and guidance with your hands.

After looking carefully at your referral, you have been assessed as being suitable for our rheumatology pathway. This is for patients with conditions such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, lupus, fibromyalgia and hypermobility where the hands are affected.

Because these conditions are long-term, symptoms are changeable and variable. Although there is no cure for the conditions, there are things you can do to ease the symptoms and improve your health and wellbeing.

The advice and guidance provided here aims to help you to better understand and manage your condition, make sense of the signs and symptoms and give yourself better control. The resources can support you to protect your joints and to understand the small changes you can make to your lifestyle to improve your condition.

If your symptoms change or get worse even though you are following this advice and guidance, please contact your GP practice or the healthcare professional who referred you. Similarly, should there be no improvement after you have used the self-help tools, then we may look to explore further management options, such as a face-to-face appointment.

Guidance from the National Institute for Health and Care Excellence (NICE) highlights these important facts about rheumatological conditions:

• It is diagnosed clinically and usually does not need imaging (x-ray) to confirm the diagnosis
• Management should be guided by symptoms and physical function
• The core treatments for the condition are therapeutic exercise along with information and support.

The role of the Hand Therapy team is to support you to better understand your condition and learn ways that you can manage your condition yourself. There are a few key points to be aware of for self-management of rheumatological conditions:

• Planning ahead
• Pacing yourself
• Respecting pain
• Activity changes
• Use of splints
• Movement and exercise
• Symptom relief

These are techniques for conserving energy and avoiding unnecessary strain on your joints. They also help to ease the pain and tiredness associated with over-use of your hands.

One of the best ways to help manage your symptoms is by making changes to your daily activities. This helps to keep your joints better protected through your daily life and helps to lower the risk of pain and flare-ups. These include:

• Pacing yourself to prevent the over-use of your hands and any pain or swelling that results from this
• Planning ahead to help you pace yourself effectively and make sure you can still complete the most important tasks
• Good hand positioning to help you to spread weight more safely through your joints and avoid overexerting the small joints in the fingers, thumbs and wrists
• Using aids and gadgets to help you complete tasks independently with less effort and pain

You can make small changes to introduce these principles to your daily routine. It can take several weeks to start to see a difference, so it is important to continue to follow the principles to achieve the benefits.

This leaflet helps to further explain how these principles can be achieved in your day-to-day life:

Joint Protection and Activity Modification - information leaflet[pdf] 495KB

Exercises can help you to maintain and improve your movement and to increase your strength. These exercise sheets set out typical exercises we may give you to help you manage your condition. Please read all the advice and guidance in the exercise sheets, including the aims of each exercise:

• Rheumatology Strength Exercises Information Sheet [pdf] 240KB
• Rheumatology Movement Exercises Information Sheet [pdf] 400KB

It is normal for joint pain to get worse when you start exercises. Advice from the National Institute for Health and Care Excellence (NICE) says that:

• Doing regular and consistent exercise will benefit your joints, even though this may initially cause pain or discomfort
• Sticking to an exercise plan increases the benefits by reducing pain and improving your functioning and quality of life

Further information about exercise and arthritis:

• Versus Arthritis - exercising with arthritis
• Versus Arthritis - exercises for healthy joints

Splints can be a helpful to support your joints during activity and to help you to rest more comfortably at night.

However, if they are not used correctly or they are overused they can also lead to weakness or stiffness in your joints getting worse.

NICE guidance suggests splints and braces should not be routinely used unless your joints are unstable, exercise is not having an effect, and use of the splint or brace is considered likely to improve your hand movement and function.

If you are buying a splint, please read the manufacturer's guidance on fitting and size guides carefully and choose the least restrictive splint available. For further guidance, please read our Splinting advice - leaflet[pdf] 430KB

Many online retailers, high street health shops, pharmacies, and mobility aid shops stock splints and braces.

Our in-person Hand Therapy service in Northamptonshire can provide support for you in the following areas:

• If the exercises included on this page have not been effective and you want to try further exercises for stiffness, strength or swelling
• Provision of functional day splints if you need support for certain joints in daily activity (for example, the base of the thumb for pain or instability) and if self-purchased splints are not effective
• Further support in understanding your condition and how to self-manage this in the longer-term (non-medication).

Please note, there are both advantages and disadvantages to splinting, and if you wish to be considered for splint provision you will need to have a face-to-face assessment with a member of our team. Our waiting times are currently very long and if you have not tried the management recommended above you may not be eligible for a splint.

Please consider following the advice on this page for 12 weeks. After this time, if you feel that further input is required and you wish to access our service for a face-to-face appointment, please 'opt in' by replying to the SMS text message you will receive.

Please note - if you have been given this information pack by anyone other than the NHFT Hand Therapy team and you wish to receive further support, please discuss with your healthcare professional (such as your GP or specialist nurse). We do not accept self-referrals.

• Versus Arthritis website
• NHS website - arthritis
• National Rheumatoid Arthritis Society website
• Looking after your joints information booklet - Versus Arthritis (pdf)
• What is arthritis information booklet - Versus Arthritis (pdf)
• Gadgets and equipment for your home information booklet - Versus Arthritis (pdf)
• Gardening and arthritis information booklet - Versus Arthritis (pdf)
• Everyday living and arthritis information booklet - Versus Arthritis (pdf)
• Fibromyalgia information booklet - Versus Arthritis (pdf)
• Fatigue and arthritis information booklet - Versus Arthritis (pdf)
• Joint hypermobility syndromes information booklet - Versus Arthritis (pdf)
• Rheumatoid arthritis information booklet - Versus Arthritis (pdf)
• Osteoarthritis information booklet - Versus Arthritis (pdf)
• Psoriatic arthritis information booklet - Versus Arthritis (pdf)
• Polymyalgia rheumatica (PMR) information booklet - Versus Arthritis (pdf)