I have very arthritic hands and have found, surprisingly enough that they don't bother me half as much on the keyboard as they do with pen and paper. But I do believe in thanking whoever gave me a gift. So, they might receive a card I have made on the computer, an email note if they are far away (but always done very personally with a picture or graphics I have done), a phone call or if they gave me something in a container, it will ALWAYS go back to them with something I have made in my kitchen. The forms change but the thank you is always there.
"Variety is not just the spice of life, it is the key to life" - Chef Michael Smith