DR. NAGLER is physiatrist-in-chief, emeritus, and professor of rehabilitation medicine at Weill Medical College of Cornell University, New York. You may send your question about exercise and long-term care to us at [email protected]. Your question could be addressed by Dr. Nagler in a future column. Osteoarthritis is the least severe form of arthritis, but it is the most common. In contrast to rheumatoid arthritis, which is a systemic and often chronic condition, osteoarthritis is directly related to age and activity, and it attacks only the joints. Osteoarthritis may be triggered by many factors that traumatize a joint, but the most common cause is simply the natural wearing away of cartilage in weight-bearing joints that occurs with use over time. In response to the erosion of cartilage, the body's defense mechanism is to order the growth of new bone. The patches of rough bone, which may become bone spurs, can impede the natural motion of the joint and cause pain. Also, a joint affected by osteoarthritis is highly susceptible to flare-ups because the cartilage, having become rough and uneven from osteoarthritis, is a source of friction for other structures that come into contact with it. Some individuals assume that clicking and cracking noises in the joints mean that they have osteoarthritis. Although such clicking and cracking may be caused by osteoarthritis, it also may be caused by—and is generally aggravated by—tight muscles and tendons, which highlights the importance of maintaining muscle flexibility. Osteoarthritis can occur in any joint, including those of the feet and hands. About 60% of adults have some osteoarthritic changes in the hands between age 50 and 75 years. The problem usually affects the tips of the fingers—especially the distal interphalangeal joints—and pain may increase when the hands are cold. In this column, we will look at some exercises that can ease the pain of osteoarthritis of the hand. Some individuals in long-term care facilities may require assistance in doing the exercises below. Individuals suffering from osteoarthritis may notice nodules alongside the finger joints, near the fingertips, or they may complain that their hands are stiff first thing in the morning. Most can get some relief by having their hands soaked in warm water for a few minutes soon after they wake up. It also is helpful to do hand exercises on a daily basis. In addition, individuals who suffer from stiffness in the thumb can rotate the thumb in the largest possible circles in order to improve mobility and maintain the web space between the thumb and first finger. These exercise strategies will help to delay disability related to osteoarthritis as well as to maintain function. Tennis ball squeeze. Have resident hold a tennis ball, then squeeze it with a steady pressure, holding as you count to 4 or 5, and release as you count to 2. Relax. Repeat 4–5 times.Show full captionThe reason for the controlled release is to allow blood to move back into the hand, which is a slower process as we age. This exercise can be done even if there is some swelling in the hands.View Large Image Figure ViewerDownload (PPT) Thumb-muscle strengthener. Have resident rotate the hands so the thumbs are facing each other upside-down. Then have him or her press the thumb of one hand against the thumb of the other hand. Hold for 5 seconds. Relax. Repeat 8–10 times daily to maintain the strength of the thumb muscles. This exercise can be done even if there is some swelling in the hands.View Large Image Figure ViewerDownload (PPT) Web-space strengthener. Have resident place both hands together in a steeple shape—thumb to thumb and fingertips to fingertips, then try to press the palms together. He or she should feel a stretch in the web space between the thumb and index finger, and between the other fingers. Hold for 5 seconds. Relax. Repeat 5–6 times. This exercise can be done even when there is some swelling in the hands.View Large Image Figure ViewerDownload (PPT) The reason for the controlled release is to allow blood to move back into the hand, which is a slower process as we age. This exercise can be done even if there is some swelling in the hands.