Hand osteoarthritis: finger pain that appears when you open a jar, turn a key or button a shirt is a frequent reason for a physiotherapy consultation after the age of fifty. In this guide you will find what really happens in the joints, how to recognise hand osteoarthritis and tell it apart from something more serious, and, this is the part almost no one writes, how much the exercises you will find below are really worth.
Here is the conclusion up front, because it is more useful than any promise: exercises for hand osteoarthritis have evidence in their favour, but it is small and of low quality. That is not a good reason to skip them. It is an excellent reason not to rely only on them, and to understand which other levers, less intuitive, have better evidence.
⚠ Important: read this before continuing
The exercises and advice in this article are general guidance and may not suit your situation. Every person has a unique clinical history: what works for others could be counterproductive for you.
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When hand pain is not osteoarthritis: the signs to check straight away
Before anything else, because the hands are one of the places where inflammatory arthritis begins and is mistaken for wear. See a doctor without waiting if you recognise any of these pictures.
Morning stiffness that does not go away. In osteoarthritis the stiffness is there but brief, and it eases as soon as you start moving your fingers. Stiffness that stays with you for much of the morning points towards inflammation, not wear.
Hot swelling of the knuckles and wrists, especially if symmetrical. Osteoarthritis typically affects the last finger joints, the middle joints of the fingers and the base of the thumb. The knuckles themselves (the metacarpophalangeal joints) and the wrists are more typical territory for inflammatory arthritis. It is no coincidence that the international classification criteria for rheumatoid arthritis weigh precisely the number and site of the joints involved, blood tests, inflammation markers and duration of symptoms, and require that synovitis is present and that there is no other diagnosis that explains the picture better.
A single joint that has suddenly become red, hot and very painful. It needs to be seen promptly: this is not how osteoarthritis behaves.
General symptoms. Fever, marked tiredness, weight loss, other joints involved: these are signs that the problem is not only mechanical.
Tingling or numbness in the first three fingers, especially at night, with loss of strength. This picture suggests compression of the median nerve at the wrist, not joint osteoarthritis, and it has a completely different treatment.
None of these signs automatically means you have a serious disease. It means the diagnosis needs to be made by someone who examines you, before starting any exercise programme.
Hand osteoarthritis: what it is and where it strikes
Osteoarthritis is the degeneration of the joint cartilage and of the structures around the joint. In the hand it concentrates in three sites.
The distal interphalangeal joints, that is, the last ones before the nail, are the most involved: when osteoarthritis affects them, Heberden's nodes appear, those bony enlargements that make the fingertips knobbly. (Not to be confused with the nodules of the palm, which are fibrous rather than bony, and pull the finger inwards: that is Dupuytren's disease.) The proximal interphalangeal joints, the middle joints of the fingers, instead produce Bouchard's nodes. These are bony deformities: once formed they do not regress, and no exercise or cream makes them disappear. It is worth knowing this straight away, because many people try one treatment after another expecting to see their fingers straighten out.
The third site is the joint at the base of the thumb, the trapeziometacarpal joint, which when it becomes diseased is called thumb base osteoarthritis (rhizarthrosis). It is the most disabling form, because the thumb takes part in almost every grip: turning a key, opening a jar, using scissors. If your problem is concentrated there, we have a dedicated article on thumb base osteoarthritis.
Hand osteoarthritis: why it develops and what you can act on
Age is the strongest factor: with the passing of years, signs of hand osteoarthritis become frequent, often visible on X-rays even in people with no symptoms at all. This mismatch between image and pain is important: a "bad" X-ray does not predict how much it will hurt.
Family history is well known in clinical practice: if your mother or grandmother had knobbly fingers, the probability that they will appear in you too is higher. Women are affected more often than men, especially after the menopause; the role of hormones in this is suspected but not established with certainty. None of these factors can be changed, which is precisely why it is better to shift attention to what you can change: how you use your hands, which tools you use, how much load you put on joints that are already painful.
An important point: before trying these exercises, make sure you have received a correct diagnosis. People often think they have one problem, when the real cause of the pain is something else. Doing the wrong exercises can make things worse rather than better.
Injuries matter: fractures, dislocations and ligament injuries of the fingers increase the risk that that specific joint will develop osteoarthritis in the following years. Other hand disorders can also overlap and confuse the picture, such as trigger finger or De Quervain's tendinitis at the wrist and thumb, which sometimes coexist with osteoarthritis in the same hand.
The characteristic symptoms
Pain is the main symptom: localised to the affected joints, it worsens with use of the hand and eases with rest. In advanced stages it can also appear at rest or at night.
Stiffness is felt on waking or after being still, but it is short-lived and gives way when you move your fingers, the opposite of what happens in inflammatory arthritis.
Deformities (Heberden's and Bouchard's nodes and, in advanced thumb base osteoarthritis, the characteristic deviation of the thumb) are structural and generally permanent.
Loss of grip strength often accompanies the picture, partly because of pain and partly because of joint instability. It is the symptom that weighs most in real life, and unfortunately it is also the one that current treatments do least for: the 2025 systematic review on treatments for hand osteoarthritis explicitly concludes that effective interventions to improve grip strength are lacking.
Hand osteoarthritis and research: what the studies really say about exercises
Here most articles write that "exercise is the mainstay of treatment". It is a simplification. Here are the numbers.
The Cochrane review on exercise in hand osteoarthritis included seven studies; five of these, for a total of 381 participants, were pooled in the pain analysis. Compared with people who did not exercise, those who did reported a reduction in pain of half a point on a scale from 0 to 10 (confidence interval from 0.1 to 0.9), equivalent to an absolute reduction of 5%. For hand function, calculated however on a different and smaller set, four studies and 369 participants, the improvement was 2.2 points on a scale from 0 to 36, with a confidence interval (from −0.2 to +4.6) that also includes no benefit at all. For finger stiffness, across the same four studies, the gain was 0.7 points out of 10. The authors write that the quality of the evidence is low and that whether these effects represent a clinically important change "may be debated".
There is a second finding, even less often cited: the benefit did not persist at medium and long-term follow-up. Two studies followed participants for six months and one for twelve, and at that distance the advantage of exercise on pain, function and stiffness had disappeared. The most recent systematic review, from 2025, places the long-term effect of hand exercises on pain as small and with low certainty of the evidence.
Side effects must also be mentioned: three studies recorded them, and they were few and not serious, but they consisted precisely of an increase in inflammation of the finger joints and of hand pain. The estimate of risk is too imprecise to draw conclusions from, and this is in any case a reason not to insist on an exercise that makes your finger swell.
Why do them, then? Because the benefit, however small, exists; because the costs and risks are minimal; and because the main international guidelines, both the European EULAR ones and the American ones from the American College of Rheumatology, continue to recommend exercise as part of first-line management. The difference lies in expectations: exercises are one of the tools, not the cure. If you expect them to make pain disappear you will be disappointed and abandon them; if you expect a modest help to keep up over time, you will use them in the right way.
Exercises for hand osteoarthritis: which to do and how to use them
An honest note on dosage: in the studies included in the Cochrane review the frequencies were very different from one another: two or three times a week in four studies, every day in two, and three or four times a day in another. There is therefore no proven "right" dosage. The practical rule I use in the clinic is: little, often, and always below the threshold at which the joint becomes inflamed.
Opening and closing the hand. Fully open your hand, extending all the fingers, then close it into a fist as far as you can without forcing. Repeat 10 to 15 times, several times a day. Doing it with your hands immersed in lukewarm water makes the movement more comfortable.
Thumb opposition. Touch the tip of your thumb to the tip of each finger, forming an O. Repeat 10 times. It serves to maintain mobility of the joint at the base of the thumb, the most limiting when it stiffens.
Flattening the fingers on the table. Rest your hand on the table with the palm down and try to flatten your fingers against the surface, without pushing to the point of pain. Hold the position for about thirty seconds and repeat.
The C grip. Form a C with your hand, as if grasping a glass, hold for five seconds and straighten. Repeat 10 times. It is the exercise closest to a real action, and for this reason the most useful to carry over into the day.
On strengthening the caution seen above applies: the evidence that grip strength can be recovered in hand osteoarthritis is weak, and squeezing balls is no exception. If your goal is strength in general, with healthy hands or with a different problem, we cover it in more depth in the guide on how to strengthen your grip.
Heat, cold and splints: what to expect
Heat before movement and cold after an activity that has inflamed the fingers are low-risk remedies that many people find useful. The American College of Rheumatology guidelines place them among the conditional recommendations: exactly what that means, reasonable to try, without strong evidence behind them.
The splints section deserves more space, because it is where the sources contradict each other in an interesting way. The same American guidelines recommend strongly a splint for osteoarthritis at the base of the thumb, and it is one of the few strong non-pharmacological recommendations for the hand. The 2025 review estimates for thumb splints a moderate effect on pain in the long term, again with low certainty of the evidence.
Then there is an English randomised trial of 349 people with symptomatic osteoarthritis at the base of the thumb and at least moderate pain and difficulty using the hand, conducted in 17 hospital departments of the British National Health Service, which compared three groups: a self-management programme delivered by therapists, the same programme plus a real splint, and the same programme plus a placebo splint. On the main outcome, hand pain after eight weeks, available for 292 participants, 84% of those randomised, all groups had improved, but there was no difference between the groups: the real splint gained half a point of pain relief over the programme alone, a gap compatible with chance. The authors' conclusion is precise: adding a splint to a good self-management programme guided by therapists brings no further benefit.
Read it carefully, because this is an easy mistake: that study does not say the splint is useless. It says it adds nothing to a self-management programme that is already well delivered. If you do not have access to that programme, the splint remains a sensible option to try. If instead you are already following a structured pathway with a professional, do not expect the splint to make the difference.
The intervention with the best evidence (and it is not what you think)
This is the passage that makes the article worth reading. In the 2025 systematic review on treatments for hand osteoarthritis, the highest level of evidence among non-pharmacological interventions goes neither to exercises nor to splints: it goes to aids for daily life, with moderate certainty for a moderate and lasting effect on hand function. The European EULAR recommendations also place aids among the top three recommendations, even before the drug part. With a necessary qualification, so as not to make the guidelines say more than they say: within those same first three EULAR recommendations there are also education, exercise and splints, all together. It is not EULAR that places aids above exercise: it is the 2025 review, looking at the certainty of the evidence, that gives them the highest rating.
In practical terms, this means changing tools and movements:
- Large grips. Enlarged handles for cutlery and tools, thick pens, keys with a lever extension. The wider the grip, the less force the thumb has to produce.
- Replace force with leverage or a motor. Electric can openers and jar openers, bottle openers with a lever, non-slip gloves for unscrewing.
- Spread the load. Carry bags on your forearm or with both hands instead of gripping the handle with your fingers; push doors with your palm or shoulder, not with your thumb.
- Avoid extreme and prolonged positions. Wringing, twisting and holding tightly for long periods are the movements that irritate osteoarthritic joints most. Alternate hands, take breaks, change your grip.
In hand osteoarthritis this is not the advice that excites, but it is the one with the best evidence. And it has an advantage that exercises do not have: it acts every time you use your hand, not only in the ten minutes set aside for it.
And medications?
This is not a physiotherapist's remit and it should be discussed with your doctor, but it is worth knowing what the European recommendations say, because they guide the right questions. EULAR indicates topical treatments as first choice, preferred to general ones, with local NSAIDs at the front line; oral NSAIDs are to be considered for symptom relief and for a limited duration. Corticosteroid injections into the joint are not generally recommended, but may be considered in particularly painful interphalangeal joints. Disease-modifying antirheumatic drugs, those used in rheumatoid arthritis, are explicitly advised against in hand osteoarthritis.
If you are wondering whether anything exists that stops the process, the answer for now is no: we have discussed it at length in osteoarthritis: can it be treated?.
Where teletherapy can help
When the room for improvement is narrow, as in this case, the selection of exercises, correct execution and above all the adaptation of everyday movements matter a great deal. That is the part with the best evidence and also the hardest to put into practice alone, because it requires someone to watch how you really open a jar or how you really hold a pen.
The hand is one of the sites that can be assessed best at a distance: the physiotherapist sees the joints, the mobility, the quality of the movements and the compensations directly through the camera. With Ri-Hub the physiotherapist follows you from home, corrects your technique, adapts the programme over time and tells you honestly when it is worth turning to a rheumatologist or a hand surgeon. A teletherapy session costs 29,90 euro.
Conclusion: realistic expectations, concrete results
Hand osteoarthritis is a chronic condition that is not cured and is managed over time. Exercises give a small benefit, which in the Cochrane review did not persist at six and twelve months, while the 2025 review credits them with one that is also small and of low certainty in the long term, but they cost little and it is worth including them in your routine. Splints help above all those who do not already have a guided pathway. The change with the strongest evidence is the least spectacular: modifying tools and movements so that the joints work less hard every day. If you combine these three things and stop looking for the definitive solution, your hands will work better and for longer.
If the pain appeared during the menopause, the picture has its own features: we discuss it in joint pain in menopause: why it comes and what works.
On joint supplements, what to really expect: Collagen for joints: does it really help?.
Sources
- Exercise for hand osteoarthritis, Cochrane Database of Systematic Reviews, 2017
- Efficacy and safety of non-pharmacological, pharmacological and surgical treatments for hand osteoarthritis in 2024: a systematic review, RMD Open, 2025
- 2018 update of the EULAR recommendations for the management of hand osteoarthritis, Annals of the Rheumatic Diseases, 2019
- 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee, Arthritis Care & Research, 2020
- The clinical and cost effectiveness of splints for thumb base osteoarthritis: a randomized controlled clinical trial, Rheumatology (Oxford), 2021
- 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative, Annals of the Rheumatic Diseases, 2010
Last source check: August 2026.
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