Hand and Joint Involvement in Systemic Sclerosis (SSc/Scleroderma)

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Sclerodactyly and Scleroderma
Joint Contractures
Joint Inflammation and Carpal Tunnel Syndrome


Hand and joint involvement in scleroderma includes the fingers, knuckles, wrists, knees, and other joints. Hand involvement includes sclerodactyly, joint contractures, inflammation and carpal tunnel syndrome.

On this page we cover joint contractures, joint inflammation, and carpal tunnel syndrome. We also provide information on how to treat some of these problems through exercise and non-medicinal means.

Development of a Modified Hand Mobility in Scleroderma (HAMIS) Test and its Potential as an Outcome Measure in Systemic Sclerosis (SSc). The mHAMIS involves 4 easily measurable items and has the potential to be a relevant clinical measure of outcome in the evaluation of fibrotic skin involvement in SSc. PubMed, J Rheumatol, 2014 Oct 1.

Joint and tendon involvement predict disease progression in systemic sclerosis (SSc): a EUSTAR prospective study. Joint synovitis and tendon friction rubs are independent predictive factors for disease progression in patients with early SSc and these easily detected clinical markers may be useful for the risk stratification of patients with SSc. PubMed, Ann Rheum Dis, 2014 Aug 27. (Also see Tendon Friction Rubs)

Sclerodactyly and Scleroderma

Photo of severe sclerodactyly in a systemic scleroderma patientSclerodactyly is when the skin on the fingers can become tight, stretched, wax-like, and hard. This can cause the fingers to curl inward and become frozen in a clawed position (as shown in the picture). Sclerodactyly is commonly associated with atrophy of the underlying soft tissues. (See Scleroderma Photos) ISN

Joint Contractures

Joint contratures are recognized by the loss of joint motion or a high resistance to a passive stretch. In scleroderma, joint contratures can be due to fibrosis of the tissue supporting the muscles or joints, such as tendons and ligaments, or the muscles themselves.

Characteristics of Joint Involvement and Relationships with Systemic Inflammation in Systemic Sclerosis: Results from the EULAR Scleroderma Trial and Research Group (EUSTAR) Database. Our results highlight the striking level of articular involvement in SSc, as evaluated by systematic examination in a large cohort of patients with SSc. Our data also show that synovitis, joint contracture, and tendon friction rubs are associated with a more severe disease and with systemic inflammation. Avouac J. (PubMed) J Rheumatol, 2010 Jun 15.

Photo of Finger Contracture

Joint Inflammation and Carpal Tunnel Syndrome

Scleroderma can also cause joint inflammation (pain, redness and/or swelling) which is usually treated with NSAIDS or other anti-inflammatories. Carpal tunnel syndrome (CTS) is often an initial symptom of scleroderma (usually along with Raynaud's), preceding the development of other symptoms by months or years.

Low-field magnetic resonance imaging study on carpal arthritis in systemic sclerosis (Ssc). Arthritis in SSc may be caused not only by immunological inflammation but also by ischemic mechanisms. Arthritis Research & Therapy 2013, 15:R2.


Physical and occupational therapies are also very helpful to minimize impairments and disabilities, and should be started at the first stages of hand involvement to prevent or ameliorate finger contractures. Likewise, physical and occupational therapies are also necessary at the first stage of skin tightening on the legs.

For optimum results, make every effort to seek out a physical or occupational therapist well-versed in scleroderma (few are, since scleroderma is so rare) — and diligently follow their advice.

An out-of-print 32-page pamphlet, Scleroderma Caring for Your Hands and Face by Jeanne L. Melvin, MS, OTR, FAOTA, is full of exercises for your hand and face to help maintain mobility. It also shows how to measure your mouth and hands to see how much the exercises are helping. It explains the importance of relaxing the hands before stretching. Also there are general tips for dealing with Scleroderma. It was originally published by the American Occupational Therapy Association, however they no longer distribute it, and it is not available on Amazon even as an out-of-print publication. Some people have been able to find it (sometimes by specially requesting it) through their local library. We highly recommend trying to get it that way.

Because scleroderma is a type of arthritis, exercises and stretching suggested for rheumatoid arthritis and other types of arthritis may prove to be beneficial. Remember, never stretch to the point where it becomes painful!

Telemedicine Applied to Kinesiotherapy for Hand Dysfunction in Patients with Systemic Sclerosis and Rheumatoid Arthritis: Recovery of Movement and Telemonitoring Technology. Telemonitoring of self-administered kinesiotherapy programs is a promising approach to the rehabilitation of hand functions in patients with rheumatic disease. PubMed, J Rheumatol, 2014 Jun 1.

Hand Exercises for Rheumatoid Arthritis. 7 hand-stretching exercises to ease rheumatoid arthritis symptoms. Denise Mann, Web MD.

The Mayo Clinic's Slide Show: Hand exercises for people with arthritis. Hand exercises may help improve muscle strength and joint range of motion in people who have arthritis. You can do hand exercises daily or, preferably, several times a day. Mayo Clinic.

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