MS and hand pain

6 Hand Exercises for Multiple Sclerosis

2. Finger Abduction and Adduction

Straighten the thumb and fingers of one hand. Spread the fingers apart and then squeeze them together; repeat with the other hand. Perform three to five repetitions to start; progress to 10 to 15 reps once, and then twice, a day. To add resistance, place a rubber band around your fingers when they’re in the closed position (it should fit snugly), and then spread them apart, pressing against the band. You can also use a small rubber band on two or three fingers at a time.

RELATED: Rehabilitation for People With Multiple Sclerosis

3. Finger Pinch

Roll a washcloth or putty into a tube shape. Using your thumb and index finger, pinch along the tube from one end to the other; repeat with your other hand. To strengthen your palm, use your thumb, index finger, and third finger to pinch a washcloth or putty or Nerf ball; repeat with the other hand. Repeat either exercise three to five times with each hand, working up to 10 to 15 reps.

4. Rice Exercises

Place a large bag (or two) of rice in a big bucket. Place your hands in the bucket and open and close them in these various positions:

  • Palms facing each other
  • Palms facing away from each other
  • Palms facing your body
  • Palms facing away from your body

You might also rotate your hands in a clockwise direction, and then counterclockwise, in the rice.

“You can also try this exercise with sand,” Luketic says.

5. Movement Therapy, or ‘Piano Hands’

Sit up tall in a chair, facing a table or desk. Place your hands, palms down, on the edge of the table (your forearms should be hanging off). Lift your fingers up and down, one at a time, as if you were playing the piano. Then move them up and down the imaginary keyboard. You might even do this to real music — play for 20 to 30 seconds of a tune to start.

“Gradually increase the time until you can play an entire song,” Luketic says.

6. Massage and Dexterity Exercises

Massage therapy can help with burning or prickling feelings or numbness in the hands. You can also try some hand physical therapy or hand occupational therapy, such as playing cards or video games, doing crafts that require dexterity, or try typing at your computer keyboard or organizing your desk or kitchen drawers. Include some stretching in your routine as well.

These exercises and activities won’t make hand pain and numbness go away, “but stretching helps get more blood flowing to your hands and can help you increase movement and manage tightness,” Luketic says.

How does Dawson’s finger relate to multiple sclerosis?

Share on PinterestDawson’s finger is a lesion that might develop in people with MS.

In 1916, Dr. James Walker Dawson noticed a pattern of plaques in the brains of people with MS. Now, these so-called lesions that doctors call Dawson’s fingers are a typical sign of MS.

In one 2014 study, researchers identified Dawson’s finger in a majority of participants with MS. Two researchers looked at the brains of the same participants. One reported Dawson’s fingers in 92.5% of people with MS, and the other researcher noted their presence in 77.5% of people.

Demyelination leaves behind plaques in the brain. These are often visible on brain scans. Dawson’s finger develops around a band of nerve fibers that connect the brain’s left and right hemispheres. The plaques form at right angles around veins in the brain’s ventricles.

The presence of Dawson’s fingers on a brain scan alone is not enough to for a doctor to diagnose MS, however. Depending on the type of evidence and the part of the body involved, a doctor will seek evidence of at least one attack and one lesion before confirming an MS diagnosis.

When doctors examine a Dawson’s finger lesion, they use it to judge the spread, or dissemination, across the nervous system.

Dissemination in space (DIS) of a lesion suggests the extent of the disease’s spread, while dissemination in time (DIT) can suggest multiple attacks. A doctor can use the dissemination of the lesion to predict the progression of the disease.

Before confirming MS, a doctor must find no evidence that another condition, such as an infection or brain injury, caused the symptoms.

Dawson’s fingers are just one sign of damage that can point toward MS. If a brain scan shows Dawson’s fingers, but a person has no other symptoms, or if they have only had one MS attack, their doctor might continue to monitor them.

The doctor may not confirm a diagnosis of MS until a person presents more symptoms.

Other MS tests

MRI brain and spinal cord scans check for a number of changes in the CNS and not only Dawson’s fingers.

Doctors will check for signs of demyelination in the brain and spinal cord. Brain scans can also help to track the progression of MS over time.

Sometimes, scans show lesions in an area of the brain that does not produce symptoms of MS. These lesions offer an early warning that a person may eventually develop symptoms of the condition, however.

A doctor can use the presence of any of these lesions to request further testing, such as a brain MRI, to confirm the diagnosis. This intervention allows a person to start a course of treatment early and address symptoms before they can become disruptive.

Some other tests that support an MS diagnosis include:

  • Lumbar puncture: A doctor may use this to collect cerebrospinal fluid (CSF). In this spinal fluid, they might find oligoclonal bands. These bands are products of autoimmune activity in the CSF that might indicate a range of inflammatory disorders in the CNS, including MS.
  • Evoked potentials test: This test measures electrical activity in the brain, indicating how the nerves are communicating with one another.
  • Optical coherence tomography: This technique uses imaging to look at the nerves at the back of the eye, which may also indicate problems.

The doctor will also check whether symptoms have developed due to any other illness. A history of the individual’s symptoms can help the doctor determine which tests are most appropriate for confirming MS and ruling out other conditions.

Dawson’s fingers and other brain disorders

Although Dawson’s fingers do not usually develop due to other brain disorders, not everyone with Dawson’s fingers displays symptoms of MS.

As brain scans are not always clear, a doctor could also mistake different brain changes for Dawson’s fingers.

A 2014 study explored the ability of medical evaluators to differentiate symptoms of MS from symptoms of neuromyelitis optica spectrum disorders (NMOsd). NMOsd are immune-mediated disorders that, like MS, trigger demyelination. However, NMOsd typically target optic nerves, therefore affecting a person’s vision.

One evaluator saw Dawson’s fingers in an individual with NMOsd, suggesting that others might either misinterpret MRI findings or that Dawson’s fingers may be present in some other medical disorders.

Pain is a common symptom in MS, with up to two-thirds of people with MS reporting pain in worldwide studies. Those who experience pain may find it affects their daily life activities, such as work and recreation, and their mood and enjoyment of life.

Why does pain occur in MS and what are the common types?

Steady and achy types of pain in MS may be a result of muscles become fatigued and stretched when they are used to compensate for muscles that have been weakened by MS. People with MS may also experience more stabbing type pain which results from faulty nerve signals emanating from the nerves due to MS lesions in the brain and spinal cord.

The most common pain syndromes experienced by people with MS include:

  • headache (seen more in MS than the general population)
  • continuous burning pain in the extremities
  • back pain
  • painful tonic spasms (a cramping, pulling pain)

Experts usually describe pain caused by MS as musculoskeletal, paroxysmal or chronic neurogenic.

Musculoskeletal pain can be due to muscular weakness, spasticity and imbalance. It is most often seen in the hips, legs and arms and particularly when muscles, tendons and ligaments remain immobile for some time. Back pain may occur due to improper seating or incorrect posture while walking. Contractures associated with weakness and spasticity can be painful. Muscular spasms or cramps (called flex or spasms) can be severe and discomfiting. Leg spasms, for example, often occur during sleep.

Paroxysmal pains are seen in between five and ten per cent of people with MS. The most characteristic is the facial pain of trigeminal neuralgia, which usually responds to anticonvulsants such as carbamazepine, oxcarbazepine and lamotrigine.

Lhermittes is indicated by a stabbing, electric-shock-like sensation running from the back of the head down the spin brought on by bending the neck forward. Medication is of little use because this pain is instantaneous and brief, but anticonvulsants may be used to prevent the pain, or a soft collar to limit neck flexion.

Neurogenic pain is the most common and distressing of the pain syndromes in MS. This pain is described as constant, boring, burning or tingling intensely. It often occurs in the legs.

Paraesthesia types include pins and needles, tingling, shivering, burning pains, feelings of pressure, and areas of skin with heightened sensitivity to touch. The pains associated with these can be aching, throbbing, stabbing, shooting, gnawing, tingling, tightness and numbness.

Dysesthesia types include burning, aching or girdling around the body. These are neurologic in origin and are sometimes treated with antidepressants.

Optic Neuritis (ON) is a common first symptom of MS. Pain commonly occurs or is made worse with eye movement. The pain with ON usually resolves in between seven and ten days.

Treatment of pain in MS

Exercise and physical therapy may help to decrease spasticity and soreness of muscles. Regular stretching exercises can help flexorspasms. Relaxation techniques such as progressive relaxation, meditation and deep breathing can contribute to the management of chronic pain.

Other techniques which may relieve pain include massage, ultrasound, chiropractic treatments, hydrotherapy, acupuncture, transcutaneous nerve stimulation (TENS), moist heat and ice.

Pain from damage to the nerves in the central nervous system in MS is normally not relieved by the usual analgesics (such as aspirin). Drugs that treat seizures (like carbamazepine) and antidepressants (such as amitriptyline) are often effective in these cases. Treatment for spasms can include baclofen, tizanidine and ibuprofen.

Conclusion

Pain is MS is a hidden symptom, but one which can be persistent. Pain can cause long-term distress and impact severely on people’s quality of life. Self-help may play an important role in pain control; people who stay active and maintain positive attitudes seem more able to reduce the impact of pain on their quality of life.

Download the MS in focus magazine (you will need Acrobat Reader to view these files):

Aversa, Italy, 03/2012. Like many people with MS, Stefania Salzillo finds it difficult to cope with the daily injections of Interferon-b. Her boyfriend, Ernesto Lodice, helps out providing both practical and emotional support. But access to medication was relatively quick: she received her first prescription within two months of being diagnosed. The cost of DMDs in Italy is 100% covered by the national health plan. Credit: Walter Astrada. Published on this website by kind permission of the European Multiple Sclerosis Platform.

Minsk, Belarus, 10/2011. Alena Kleshchanka (51) has spent most of the past seven years organising her days around Nicolai’s needs. Blind and virtually paralysed from the neck down, Nicolai is mentally sharp. While the physical burden of care is heavy for Alena, the couple continue to share a loving relationship. Credit: Walter Astrada. Published on this website by kind permission of the European Multiple Sclerosis Platform.

Numbness

A very common symptom of MS is numbness, often in the limbs or across the body in a band-like fashion. Numbness is divided into four categories:

  • Paresthesia – feelings of pins and needles, tingling, buzzing, or crawling sensation
  • Dysesthesia – a burning sensation along a nerve; changes in perceptions of touch or pressure; nonpainful contact becomes painful
  • Hyperpathia – increased sensitivity to pain
  • Anesthesia – complete loss of any sensation, including touch, pain, or temperature

The first three types of numbness – paresthesia, dysesthesia, and hyperpathia – are all frequently seen at various times and to various degrees in people with MS. The fourth type, anesthesia, is rarely experienced by someone with MS.

Sensory symptoms tend to come and go for most people and usually carry a good prognosis for not becoming permanent. Often, the change in sensation occurs only along a patch of skin or in specific areas, such as one or both hands, arms, or legs. For someone not yet diagnosed with MS, numbness is not necessarily indicative of the disease. A number of conditions can cause similar symptoms of numbness. Among others, these include diabetes, carpal tunnel syndrome, toothache, back and neck problems, vitamin deficiencies, anemia, and even tight clothing.

Treatments for Numbness

When caused by MS, numbness is typically harmless, often producing little or no pain. Medications are not typically prescribed for this condition, unless it becomes painful or dysesthetic (pain when skin is touched). According to some individuals with MS, thinking too much about this symptom can actually increase the sensation of numbness, so most try to ignore this symptom.

Should medication be prescribed, steroids (such as cortisone) may improve the condition by reducing inflammation. This can be particularly helpful if lack of sensitivity has impaired functioning to a point where activities are affected. In general, however, steroids are best avoided whenever possible in order to reserve their use for a more serious medical need.

Niacin (one of the B complex vitamins) sometimes assists with reducing numbness. Neurontin® (gabapentin), Lyrica® (pregabalin), Dilantin® (phenytoin), and Tegretol® (carbamazepine) are antiseizure drugs which may be prescribed for controlling painful burning or electric shock-like sensations. Other modern anticonvulsants may also be prescribed. Elavil® (amitriptyline) is a tranquilizer and antidepressant that may be effective in reducing numbness. Its list of side effects includes drowsiness; therefore, this medication should only be taken when able to rest or at night before going to bed. Other antidepressants, such as Pamelor® (nortriptyline) or Tofranil® (imipramine), may also be tried.

Despite the drugs mentioned, medications are rarely prescribed for this condition alone, unless the sensory symptoms are painful or dysesthetic. As with all MS symptoms, a doctor should be contacted about any numbness experienced. This is to not only confirm that the numbness is attributable to MS, but also to see if he or she may want to recommend further investigation or treatment.

► Go to Introduction to Multiple Sclerosis Symptom Management

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► Go to Multiple Sclerosis Symptom Medications

The symptoms experienced by people with MS can be grouped according to how they affect you. Some people develop lesions (nerve damage) without noticing symptoms, because the damage happens to be in a part of the brain or spinal cord which can re-route nerve signals around the damage.

Sometimes, symptoms can be caused by nerve damage within the part of the brain that deals with that part of the body. Alternatively, the nerve damage could have occurred in a nerve carrying information from the brain to the body. Damage at either of these places might result in a similar symptom. For example, a lesion in the spinal cord leading to the leg muscles or a lesion in the cerebellum part of the brain (which organises co-ordination and balance) could both result in you finding yourself stumbling or falling over.

​All of these symptoms are treatable, and are definitely worth discussing with your MS Nurse or healthcare team for further advice.

Balance and coordination

Problems with balance and co-ordination are common in MS, because the brain regions that organise these skills are often affected by nerve damage. You might experience this as dizziness, tremor or shaking, or have trouble holding yourself or part of your body in certain positions. The medical term for co-ordination problems is ataxia.

Bladder and bowel

Problems with regulating your bladder and bowel are also quite common in MS. You might find it harder to control when you need to visit the toilet during the day, or find you wake up in the night needing to urinate. Bladder and bowel symptoms can be partly due to nerve damage, but issues such as constipation or urinary tract infections can also be secondary symptoms brought on by having reduced mobility.

Thinking and memory

Problems with thinking and memory are called cognitive problems. They might include forgetfulness, finding it hard to focus or concentrate, or a general sense of being too tired to think, known as cognitive fatigue. Also included in this category might be impulsiveness, trouble making decisions, or visuospatial problems where you find you are bumping into things or having trouble finding your way around.

Hearing

Occasionally, people with MS develop hearing problems when there is nothing wrong with their ears. The problem is with the part of the brain that interprets the sound we hear.

Temperature sensitivity

It is common for people with MS to notice that their symptoms get worse with extremes of heat or cold. Some people notice an effect at both extremes, some just in one. It is thought that extreme temperatures affect the speed that nerve impulses get transmitted through the body, making any existing symptoms worse, and sometimes bringing on new symptoms like fatigue or weakness.

Mood and emotions

People with MS often find that their mood or emotions are affected, and they notice symptoms of anxiety or depression. This may be partly due to stress about having a long term condition like MS, but it might also be caused directly by damage in the brain. Less commonly, some people with MS find that they are expressing emotion in an unusual way, perhaps by laughing or crying at inappropriate times. This is called pseudobulbar affect, and is a rarer symptom of MS.

Pain

There are several fairly common MS symptoms that might involve pain of some kind. Most are temporary, but some can be more persistent. Some pain or altered skin sensations in MS are caused by nerve damage, but some might be due to poor posture or muscle spasms which put pressure on the body in some way. Nerve pain might take the form of trigeminal neuralgia, which is pain in the face that you might think is a sore tooth or earache. It might also be experienced as an uncomfortable squeezing sensation known as the MS Hug, or shooting pains in the neck and back called Lhermitte’s sign.

Sexual issues

Both men and women can sometimes find that MS can affect their participation in and enjoyment of sex. Nerve damage associated with the genital area can affect skin sensations and erectile tissue. Muscle spasms or pain can also interfere with sex.

Sleep

Problems with sleep are fairly common in MS. You might have trouble dropping off or staying asleep, or feel that your sleep is not refreshing. Some sleep issues might be directly caused by nerve damage, but other MS symptoms, like spasms, pain or nocturia (needing to urinate in the night) can also interfere with your sleep. Poor sleep can impact on other symptoms, particularly fatigue and problems with thinking and memory.

Speech and swallowing

Nerve damage in the parts of the brain responsible for language or co-ordinating the muscles of the mouth and throat can both lead to problems with speaking. You might stumble over words, or have trouble remembering the right word at the right time. Weakness and lack of co-ordination in the mouth, tongue and throat muscles can make swallowing difficult or less effective, leading to a risk of choking.

Vision

Problems with your eyesight are common in multiple sclerosis. Optic neuritis is a common early symptom, and can also occur during a relapse. It might involve feeling pain when moving the eyes, or having blurred vision, or double vision.​ Some people with MS might experience eye tremors, known as nystagmus, or problems interpreting the visual information from their eyes.

Walking difficulties

Many MS symptoms can eventually affect your walking and mobility. General weakness and fatigue can make walking harder, but muscle spasticity or foot drop can also lead to stumbling or unsteadiness. If your balance and co-ordination are affected by MS, you might notice it particularly when you walk.

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