Stiff Fingers

Stiff finger(s) can cause significant disability, and one would struggle using the hand even for simple activities of daily living (also referred as ADLs) such as cooking, eating, bathing, grasping objects and writing. There are three major causes of stiff finger(s):

1. Arthritis (see the arthritis blog for more information)

2. Prolonged or inappropriate immobilisation of the finger(s) or the hand after injury, commonly referred as post traumatic stiffness.

3. Nerve compression(please see carpal tunnel and cubital tunnel syndrome blogs)

Fig 1

Post traumatic stiffness

Post traumatic stiffness can occur in the presence or absence of an underlying hand fracture. Inappropriate immobilisation of the hand is by far the most common cause of finger(s) stiffness. Patients get caught in a vicious cycle of events after injury where pain would result in them not moving the finger(s), thereby the finger(s) become stiff, subsequently causing pain on any attempts to move the finger, which in turn results in a stiff finger. This vicious cycle should be interrupted in the early stages of rehabilitation following hand injuries to prevent post traumatic stiffness. An early review by a Hand surgeon following hand injury is of paramount importance, who would then work closely with the Hand therapist to work out an optimal rehabilitation regimen.

Fig 2

Post traumatic stiffness can affect the knuckle(metacarpophalangeal joint, also called as MCPJ), PIPJ or the DIPJ (see hand anatomy in the arthritis blog). As a result of the stiffness one may hold the finger straight (extension contracture, figure 1) or in a bent position (referred as flexion contracture, figure 2). The hand surgeon would assess the patient for the reason for the stiffness, which could be due to the tightness in the following structures:

1. Lining of the joint called capsule

2. Volar plate and collateral ligaments, structures which hold the joints in place

3. Tendons and muscles of the hand

4. Skin

Fig 3

The first step in the treatment of post traumatic stiffness is usually a period of rehabilitation under the guidance of a Hand therapist. If unsuccessful, the hand surgeon would discuss the surgical options depending on the structure(s) responsible for a stiff finger(s). The above patient with extension contracture of the middle finger was successfully treated by surgery and she can now make a full fist (figure 3).

Please get in touch through the contact us section if you would like to arrange a consultation for assessment of a stiff hand