You can’t control the amount of strength you apply when using your hands and arms. This results in uncontrolled movements and breaking fragile objects. You have a −(IE) penalty on all Strength and Dexterity checks that require fine motor control, including attack rolls.

Real-world Examples

Amyotrophic Lateral Sclerosis, Ataxia, Multiple Sclerosis, Parkinson’s Disease

Assistive Options

An additional sponge-like grip on handles can help with finger issues. Specialized utensils with long handles or sturdy cups with lids can help with eating. Be creative.

Magical Assistance

The Telekinesis or Mage Hand spells and items that duplicate their effects can assist with this for minor tasks.

Your fingers, wrists, elbows, and/or shoulders (Roll 1d8 (IE) times, 1–4 = right side; 5–8 = left side) are difficult or impossible to move without extreme pain if at all. You have a −(IE) penalty on any action that would use that joint, including attack rolls. When you succeed on a melee attack, the vibrations from the impact are painful, and you need to succeed on a DC 8 + (IE) Constitution check to fight the pain and continue to hold your weapon.

Real-world Examples

Arthritis, Lupus, Bursitis, Gout

Assistive Options

A large quantity of fish or flaxseed can help joint stiffness. A diet of at least 1 fish or a serving of flaxseed once per day for seven days will reduce the IE by 1 as long as maintained. Missing a day will lose the benefit and require starting over. Spending one hour swimming or bathing in warm flowing water will reduce the IE by 1 for 2d6 hours.

Magical Assistance

The Telekinesis or Mage Hand spells and items that duplicate their effects can assist with this for minor tasks.

You can neither feel nor move your fingers (IE 1), wrist to fingers (IE 2), elbow to fingers (IE 3), or shoulder to fingers (IE 4). Your fingers can use magic rings, but otherwise, you can’t use that appendage, and if exposed to damage, you don’t notice, which can result in further ongoing damage. Spells with somatic components usually need to be modified to work within your physical range, requiring a day for every hour normally needed to inscribe into your spellbook and double the cost due to experimentation materials.

Real-world Examples

Cerebral Palsy, Amyotrophic Lateral Sclerosis, Brachial Plexus Injury, Multiple Sclerosis, Muscular Dystrophy, Parkinson’s Disease

Assistive Options

The arm should be protected and held in place to enable proper circulation and avoid damage.

I look fine and healthy, but I’m not, and I can suddenly be in pain even if you can’t see it. I sometimes need to rest for my pain to subside even if I look alright.

– Diego Rodríguez

You experience chronic pain in your fingers, hands, and/or arms. Any action that requires concentration (e.g., maintaining a spell) requires a successful DC 10 + (IE) Constitution saving throw per round to maintain concentration. When you succeed on a melee attack, the vibrations from the impact are painful, and you need to succeed on a DC 8 + (IE) Constitution check to fight the pain and continue to hold your weapon. Because you’re used to managing pain, even though this doesn’t reduce the experience of pain, you have a +(IE) bonus to saving throws against psychic damage.

Real-world Examples

Arthritis, Carpal Tunnel Syndrome, Tendinitis, Gout, Lupus, Neuropathy, Erythromelalgia

Assistive Options

Applying ice for 10 minutes or a compression bandage can reduce the pain by 1 IE for 10d6 minutes per day.

Magical Assistance

A healing spell can target the hands and arms and reduce the IE by 2 for 1 hour instead of regaining hp.

Your arm and/or hand muscles don’t always act the way you wish, sometimes never doing so. A muscle may be permanently contracted or lacks fine motor control. IE serves as a guideline for specific effects and generally a −(IE) penalty on all Strength checks and saving throws and attacks. Spells with somatic components usually need to be modified to work within your physical range, requiring a day for every hour normally needed to inscribe into your spellbook and double the cost due to experimentation materials.

Real-world Examples

Cerebral Palsy, Muscular Dystrophy, Multiple Sclerosis, Spina Bifida, Amyotrophic Lateral Sclerosis, Arthritis, Parkinson’s Disease

Assistive Options

No mundane technology can normally assist with this, but be creative.

Magical Assistance

The Telekinesis or Mage Hand spells and items that duplicate their effects can assist with this for minor tasks.

You are missing a hand or partial forearm (IE 1), hand and partial forearm or entire forearm (IE 2), entire forearm and hand (IE 3), or entire arm and hand (IE 4). You are unable to use 2-handed weapons, a second weapon or shield, or anything else requiring two hands without a prosthesis. (If you are missing part of your arm but not your hand, you can still use a shield but not a two-handed weapon.) You have a −(IE) penalty on Strength (Athletics) checks that require two hands, such as climbing, and in mounted combat, whenever you attack or take damage, you need to succeed on a DC 8 Dexterity saving throw or fall off your mount.

Real-world Examples

Symbrachydactyly, Congenital Amputation

Assistive Options

An artisan can make prosthetic hands and arms for various purposes, with differing durability, function, and price. The base cost of a cosmetic wooden replacement is (5 + (IE)) × 50 gp, with costs increasing significantly for specialized uses. It must also be adjusted or replaced annually or when you experience any major physical changes. A prosthesis designed to hold a weapon will still have a penalty of −(IE) on attack rolls with that hand due to the prosthesis’s lack of feeling and fine motor control.

Your fingertips are more sensitive than most people’s, giving +(IE) on Wisdom (Perception) checks involving touch, but you are unable to wear gloves, gauntlets, or anything else on your hands without extreme discomfort. The GM may require Constitution checks for other hand sensitivity-related situations.

Real-world Examples

Finger Paresthesia, Arthritis, Lupus, Sjögren Syndrome, Gout, Scleroderma

Assistive Options

The best treatment is avoiding stimuli that cause discomfort.

You have fingers atypical for your ancestry. Choose or roll on the following table. This trait is typically permanent. Except for Undergrowth and Missing, gauntlets and other handwear need to be custom made and cost 50−100 percent more than usual.

• Shape Diversity. 1d10 of your fingers bend in odd directions, curving sideways or even backwards. (Roll 1d10 for the number of fingers, then 1d10 for each to determine which finger.) Depending how many fingers are diversely shaped from each hand, you have penalties to any action using your hands. The GM should determine the penalties but can use −1 per 2 fingers on each hand. Each atypically shaped thumb gives a −1 penalty itself. If most or all of your fingers curve backwards, you may be mistaken for a Rakshasa.
• Missing Fingers. You are missing 1d10 fingers. (Roll 1d10 for the number of fingers, then 1d10 for each to determine which finger.) Depending how many fingers are missing from each hand, you have penalties to any action using your hands. The GM should determine the penalties but can use −1 per 2 missing fingers on each hand. Each missing thumb gives a −1 penalty itself.
• Overgrowth. 1d10 of your fingers are longer than expected for your ancestry. This has no immediate game mechanic but will lead to confusion, fear, or other social effects, depending on the situation.
• You have (IE) extra fingers on your hand(s). You have a +(IE) bonus to Dexterity (Sleight of Hand) checks and Charisma (Performance) checks to play fingered musical instruments. This may lead to confusion, fear, or other social effects, depending on the situation.
• Syndactyly. 1 + (IE) of your fingers are fused together. This gives you a −(IE) penalty to Dexterity (Sleight of Hand) checks.
• Talons. Your fingers end in claws or talons. This allows you to make an unarmed strength attack that does 2 (1d4) slashing damage. This also gives you a −(IE) penalty on Dexterity (Sleight of Hand) checks.
• Undergrowth. 1d10 of your fingers are smaller and weaker than expected. (Roll 1d10 for the number of fingers, then 1d10 for each to determine which finger.) Depending how many fingers are undergrown from each hand, you have penalties to any action using your hands. The GM should determine the penalties but can use −1 per 2 undergrown fingers on each hand. Each undergrown thumb gives a −1 penalty itself.
• Webbed. Your fingers are webbed and give you advantage on Strength (Athletics) checks on swimming. This also gives you a −(IE) penalty to Dexterity (Sleight of Hand) checks. Note: In the real world, human webbed digits do not give swimmers any noticeable benefits.)

Real-world Examples

Clubhand, Syndactyly, Congenital Constriction Band Syndrome, Polydactyly, Symbrachydactyly, Arthritis, Swan-Neck Deformity, Boutonnière Deformity, Dupuytren Contracture, Down Syndrome

Assistive Options

An enterprising artisan might be able to make prosthetic fingers that bend with other fingers, but these would have no feeling and no advantage on game rolls.

Your vocal cords function differently than those of most of your ancestry. Choose or roll on the following table. These traits are typically constant, but the player and GM can choose fantasy reasons for variation.

• Noisy Breathing. Sound comes from your mouth involuntarily. You have a −(IE) penalty on all Dexterity (Stealth) checks where sound is a factor.
• Pitch Irregularity. Your voice is noticeably higher (50 percent) or lower (50 percent) than expected for your ancestry and gender. If higher, your normal speaking pitch is 1 + ((IE) × 2) octaves higher than a typical range. If lower, your average pitch is 1 + ((IE) × 2) octaves lower than a typical range. A lower voice gives you +(IE) on Charisma (Intimidation) checks, but your voice is harder to understand, which gives you −(IE) on Charisma (Persuasion) checks. A higher voice has −(IE) on Charisma (Intimidation) checks. This vocal difference will also penalize Charisma (Performance) checks accordingly for most singing.
• Reverberation. Your voice reverberates in your body, causing an uncontrollable echo effect. This gives you +(IE) to Charisma (Intimidation) checks but, since even your breath has a certain amount of reverberation, you have −(IE) to Dexterity (Stealth) checks where sound is a factor.
• Silent. You lack functional vocal cords, leaving you with no audible voice. You cannot use spell scrolls, and spells with a verbal component require you to modify them to add additional somatic components if possible. The complexity of this change requires one day for every hour usually needed to inscribe it into your spellbook and twice the cost due to additional experimentation needed. This trait has no IE.
• Uncontrolled Volume. You have little or no control over the volume of your voice, either too loud (50 percent) or too quiet (50 percent) as described in the following table. Too loud gives you −(IE) to Dexterity (Stealth) checks as sounds can sometimes slip out but +(IE) to Charisma (Intimidation) checks. Too quiet gives you a −(IE) to Charisma (Persuasion), Charisma (Intimidation), and Charisma (Performance) checks that use voice.
  

  IE	Loud Voice	Quiet Voice
  1	Conversational volume, can’t talk quieter	Conversational volume, can’t talk louder
  2	Always project your voice	Always mumble
  3	Always yell as loud as possible	Always whisper
  4	Always talk louder than humanly possible	Always whisper so quietly that enhanced hearing or very close proximity is needed to hear

• Wheezing. Your voice is scratchy and accented by coughing and wheezing. You experience a −(IE) on vocal Charisma checks, and when you use spells with a verbal component, you must succeed on a DC 8 + (IE) Constitution check. On a failed check, the spell is not cast and does not use a spell slot.

Real-world Examples

Paradoxical Vocal Fold Movement, Vocal Cord Dysfunction, Vocal Cord Paralysis

Assistive Options

Loud disabilities can be muffled with a mask that muffles the mouth, reducing the effect by 1 IE but making breathing difficult, causing a −1 penalty on Constitution checks related to exertion. All of these can benefit from learning a sign language, which can be exchanged for any language or proficiency.

Magical Assistance

A Helm of Telepathy or other magic that allows for nonverbal communication can assist with vocal disabilities.