Stiff Hands
A variety of problems can cause hand stiffness. Stiffness can limit use and function. Things that we used to do without thinking may now be difficult or impossible. Stiffness can occur when there are problems within or around the structures of a joint. Joints are where two bones come together. Ligaments are soft tissue that connect the bones together. Ligaments allow a joint to move, but they also limit motion in unintended directions. Some of these problems may include:
- Arthritis
- Fractures
- Dislocations
- Sprains
- Tendon and muscle injuries
Evaluating Hand Stiffness
Your doctor will ask when the stiffness began. They may also ask how it has progressed. It may be helpful to know if the stiffness occurred very slowly or suddenly. They will want to know about any prior injuries, other medical conditions, and any prior treatment, including which treatments helped and which ones did not help.
Your doctor’s careful physical examination will include looking for swelling or deformities of the bones or joints. They will check the range of motion and will look for active motion, which is what you can do on your own. They will also check for passive motion, which is the ability to move a joint farther than you can do on your own. They will feel the stiff area to look for tenderness and evaluate muscle and tendon function. They will check blood flow and sensation. They may stress the ligaments at the joint to look for instability or pain.
X-rays are usually taken to evaluate for arthritis. They will assess joint alignment and joint space. They can see if there is calcification in the soft tissue or loose bodies. X-rays can identify if there is a current or prior fracture. For special situations, other tests may be considered such as an MRI or CT scan.
Treatment
Treatment for hand stiffness can include multiple steps. When stiffness is recognized early, it may be treated more successfully. After an injury or surgery, prevention is often the best treatment. It is helpful to control pain. Acetaminophen and non-steroidal anti-inflammatories are often used as main medications. Check with your doctor to make sure these medications are appropriate based on your other medical conditions. Occasionally, for severe post-operative pain, a short course of stronger pain medication is considered. The CDC recommends opioid pain medications should be prescribed for acute post-surgical pain for three days or less.
Finger motion decreases swelling. Fingers that are swollen have more trouble moving. By treating the swelling, you can improve motion. Ice can decrease swelling, too, and is often used when blood flow is normal. Apply ice for up to 20 minutes on the swollen area. Then take a 20-minute break without ice to let the tissue come back to normal temperature. To avoid frostbite, ice should be limited if the area is numb from local anesthesia. Elevating the injured limb can reduce swelling. External dressings including elastic wraps can reduce swelling, as well.
Different types of splints or casts may be used to stretch the tight joints and regain more motion (see Figures 1 and 2). Surgery may be needed if other treatments are not working or if the pain is affecting hand function. Any surgical procedure will typically require significant hand therapy post-surgery. Without therapy, the stiffness may return.
Hand Therapy
You may be referred to a therapist to learn stretching exercises for the joints and muscles. Therapy can help loosen stiff joints through specific exercises and functional activities. These can focus on isolated or complex movements. Therapy helps regain mobility at specific joints to improve function. Some terms and techniques a therapist may use include joint mobilization, tendon gliding, blocking exercises, and excursion.
There may also be times when a patient is sent to hand therapy prior to surgery. Improving motion before surgery makes it easier to maintain and recover motion after surgery. Other modalities may be indicated. Your hand therapist might apply topical medication or use an ultrasound to heat the area and reduce pain.
Other thermal treatments can be used with moist or dry heat. Fluidotherapy involves warm sand. Iontophoresis uses an electrical current to place a medication deeper under the skin. Transcutaneous electrical nerve stimulation may reduce pain. Scar massage techniques and cupping may separate skin from tendon to improve motion.
Your hand surgeon will help you decide the best approach for your situation. Successful recovery depends on the combined efforts of the surgeon, therapist, and patient.
© 2022 American Society for Surgery of the Hand
This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a hand surgeon near you.