The Stiff Hand

Selected Features of Our Program

Evaluation and Diagnosis

After injury or previous surgery, the hand can become very stiff with scar tissue. The loss of hand function that results can be disabling. After a while, any further therapy may prove useless. Patients may experience pain, stiffness, weakness, loss of coordination, and the inability to perform certain tasks. Diagnosing the true cause of stiffness requires an expert hand surgeon with considerable experience in the field of revision surgery for scarring and lost motion. There are many reasons for stiffness that involve the joints, tendons, skin, nerves, and blood vessels. Careful analysis of each of these structures and how they might affect each other is the key to proper planning and treatment.

Treatment and Recovery

When the hand surgeon first sees the patient, an evaluation of the cause of stiffness directs the initial treatment. If there is any suggestion that further non-surgical therapy will be of benefit, a comprehensive program of manual motion exercises and proper splinting is carried out. This may be all some patients require. If the scar tissue is mature and cannot be softened by therapy, then only surgery can improve the situation. Releasing scar tissue must be done in a specific sequence of steps followed by testing of motion to determine the contribution of each of the tissues to the stiffness. First the joints are set free followed by the tendons and other structures. The patient's ability to use the tendons once they are free is one of the most important points to check. There must always be back-up strategies for surgery in case the scarring is too heavy to salvage certain structures. The patient goes immediately from surgery into a daily therapy program with specific exercises and splints designed to maximize the functional recovery. Even though solving the stiff hand can be very challenging, with a good plan and a motivated patient, major improvement in pain and function can be achieved.