Hand Stiffness: Causes and Relief

Common causes of hand stiffness

Osteoarthritis

Hand osteoarthritis is wear and repair of cartilage. It causes aching, stiffness that eases within half an hour, and firm bony lumps on the end joints (Heberden's nodes) and middle joints (Bouchard's nodes). Pain at the base of the thumb makes pinching and opening jars difficult. See arthritis of the hand.

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease in which the joint lining becomes inflamed. Clues:

• stiffness for an hour or more every morning
• soft, warm swelling of the knuckles and middle finger joints, usually on both hands
• difficulty making a fist, squeezing the knuckles is tender
• tiredness and feeling generally unwell

Early treatment within the first months prevents joint damage, so this pattern needs a prompt doctor visit.

Trigger finger

The tendon that bends a finger thickens and catches in its tunnel. The finger feels stiff, clicks, or locks bent and then snaps straight. Morning is worst. See trigger finger.

Dupuytren's contracture

Thickened tissue in the palm forms nodules and cords that slowly pull fingers into a bent position. It is usually painless. You cannot lay your hand flat on a table. See Dupuytren's contracture.

Carpal tunnel syndrome

Pressure on the median nerve at the wrist causes numbness, tingling and clumsiness that people often describe as stiff, swollen-feeling hands, especially on waking. See carpal tunnel syndrome.

Other causes

• Injury: sprains, fractures and tendon injuries leave stiffness, especially after immobilization in a cast.
• Diabetes: "diabetic stiff hand" (limited joint mobility) causes thick, waxy skin and stiff fingers; you cannot press your palms flat together in a prayer position.
• Hypothyroidism: fluid and tissue swelling cause stiffness and carpal tunnel symptoms.
• Systemic sclerosis (scleroderma): tight, shiny, thickening skin of the fingers, with Raynaud's color changes.
• Gout and pseudogout: sudden, hot, swollen joint.
• Lupus and viral arthritis (for example after parvovirus): temporary stiffness and swelling.
• Cold and Raynaud's phenomenon: stiffness and numbness in the cold.
• Fluid retention in pregnancy or premenstrually.

What the doctor will check

Expect questions about which joints, how long morning stiffness lasts, swelling, numbness, psoriasis, diabetes and family history. The exam looks at joint swelling, bony nodes, grip, finger triggering, palm cords and nerve function.

Tests may include:

• blood tests: inflammatory markers (ESR, CRP), rheumatoid factor and anti-CCP antibodies, blood sugar, thyroid function, uric acid
• hand X-rays: show osteoarthritis or erosions from rheumatoid arthritis
• ultrasound: can show early inflammation
• nerve conduction studies for carpal tunnel syndrome

Relief and treatment

At home

• Warmth: soak hands in warm water for 10 minutes, or use paraffin wax baths, in the morning.
• Gentle exercises: make a soft fist, then spread the fingers wide; touch the thumb to each fingertip; bend at the knuckles only (tabletop). Do 5 to 10 slow repetitions several times a day.
• Pace activities and use tools with thick, padded handles, jar openers and electric can openers.
• Splints: night splints for carpal tunnel syndrome and thumb osteoarthritis.
• Pain relief: topical NSAID gels work well for hand osteoarthritis with fewer side effects than tablets. Oral ibuprofen or acetaminophen (paracetamol) can also help. Follow the label dose and avoid NSAIDs if you have kidney problems, stomach ulcers or heart disease.

Medical treatment

• Hand therapy with a physical or occupational therapist
• Steroid injections for trigger finger, thumb-base arthritis or carpal tunnel syndrome
• Disease-modifying drugs (such as methotrexate or biologics) for rheumatoid and psoriatic arthritis
• Surgery for persistent trigger finger, carpal tunnel syndrome, Dupuytren's contracture or severe thumb arthritis

Frequently asked questions

Why are my hands stiff in the morning?

During sleep, joint fluid and tissues settle, so joints feel stiff until you move them. Brief stiffness that fades within 30 minutes is typical of osteoarthritis. Stiffness lasting an hour or more, with swelling, suggests inflammatory arthritis such as rheumatoid arthritis and should be checked.

Is hand stiffness a sign of rheumatoid arthritis?

It can be. Rheumatoid arthritis typically causes prolonged morning stiffness with soft swelling of the knuckles and middle finger joints on both hands. Many other conditions also cause stiffness, so a doctor's exam and blood tests are needed to tell.

What helps stiff fingers quickly?

Warm water soaks, gentle finger exercises and moving your hands slowly after waking usually loosen them within minutes. A topical anti-inflammatory gel can ease aching. If stiffness lasts over an hour every day or the joints are swollen, see a doctor.

Can diabetes cause stiff hands?

Yes. Long-standing diabetes can thicken the skin and tissues of the hands, causing limited joint mobility, and raises the risk of trigger finger, Dupuytren's contracture and carpal tunnel syndrome. Good blood sugar control and hand stretches help.

Why does my finger get stuck when I bend it?

That is usually trigger finger, where a thickened tendon catches in its tunnel. The finger may click or lock and is often worst in the morning. Splinting, a steroid injection or minor surgery can fix it.