Lets talk about the stiff hand. The stiff hand is one of the hardest problems to treat when it comes to orthopedics because there are so many varying reasons a hand can become stiff. For the number of reasons a hand can become stiff, there are an equal number of treatment techniques to improve the stiff hand. We use our hands, dominant and non-dominant alike, in all of our everyday activities from ADLs like brushing our teeth, taking a shower, and getting dressed, to work activities like typing, writing, lifting, carrying, pushing, and also leisure activities like knitting, sports, cooking, and playing. Having full use of our hands is essential for living a normal everyday life and performing all the activities we need and want to do daily.
First, lets start with some basic anatomy of the hand. There are 19 bones in the hand, five metacarpals, five proximal phalanges, four middle phalanges, and five distal phalanges. These bones are connected by joints. These joints are termed Carpometacarpal joints (CMC), which connect the carpals of the wrist to the metacarpals of the hand, Metacarpalphalangeal joints (MP), which connect the metacarpals with the proximal phalanges, Proximal Interphalangeal joints (PIP), which connect the proximal and middle phalanges, and Distal Interphalangeal joints (DIP), which connect the middle and distal phalanges. There are two types of muscles in the hand, intrinsics and extrinsics. Intrinsic muscles are those that are contained entirely in the hand, they begin and end in the hand. Extrinsic muscles are those that cross over the wrist joint and often begin in the elbow or forearm and travel down to end in the hand as tendons, both flexors and extensors, which bend and straighten your fingers.
Finally, there are stabilizing ligaments and other soft tissue structures around each joint such as volar plates, joint capsules, sagittal bands, collateral ligaments, and cruciate and annular ligaments. There are also numerous neurovascular structures in the hand including radial and ulnar arteries, digital arteries, digital nerves, and the median, ulnar, and radial nerves and branches of each.
If there is an injury to any one of these structures, the balance in the hand and fingers is very easily shifted, causing stiffness in one or multiple joints or soft tissue structures surrounding the joints. Aside from a direct injury, immobilization for any length of time, whether in the proper or improper position, can also cause stiffness. Immobilization may be necessary after surgery or injury, however too long of immobilization can cause increased difficulty in recovery of function because of increased stiffness. It is always best to consult a hand surgeon or hand therapist for the latest upper extremity treatment protocols, techniques, and interventions to ensure the best treatment possible for your hand injury.
As a hand therapist, my role is treating the stiff hand is to determine what structure is causing this stiffness so interventions can be focused on the problem area, therefore allowing improvements in range of motion, swelling, strength, and overall function. Interventions include active range of motion, functional activities, passive range of motion, joint mobilizations, edema control, dynamic, static, or static progressive splinting, casting motion to mobilize stiffness,kinesiotape, and modalities like heat, paraffin wax, infrared laser, ultrasound, and e-stim.
I typically use a combination of these interventions in any given treatment session depending on the anatomy involved in the stiffness, the time since injury, and patient tolerance and acceptance. The most important idea to be stressed about rehabilitating the stiff hand is time is of the essence. If its possible to participate in early motion after injury, this is the best way to avoid stiffness.
If your hand or fingers are already stiff, then the earlier treatment is provided, the easier it will be to regain motion. The longer the stiffness is allowed to persist, the harder the rehab and the less likely for full return of motion and function.
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