Stiff Fingers
Stiff hand means limitation of movement of fingers oh hand.
Stiff hand means limitation of movement of fingers oh hand. It arises as a result of flexion and extension contracturesof the small joints of the hand. Limitation of extensionor flexion movement may be both active and passive or active alone.
Usual presentation of stiff hand is after Burn presenting as post burn contracture of hand and fingers or, Trauma or Infections of the hand.
Diagnosis of Stiff Hand
Whenever someone is presenting with stiff hand, history of trauma or burn or infection should be enquired. Details of the surgical procedures should be looked into.
A thorough clinical examination should be doneto rule out any fractures, soft tissue defects or deficiencies in hand (tendon, nerve).
Next step is to seewhether limitation is in flexion or extension plane.
- Flexion contracture– Limitation of extension movement can be due to tightness in one or more of the structures on the palmar aspect of the joint:
- Skin: Contracture from scarring results from lacerationsor palmar burns
- Palmar fascia: Dupuytren's contracture
- Flexor tendon sheath: Shortening and contracture
- Flexor tendon: This is due to tendon shortening ortendon adhesions. Temporary joint fixation in a particularposition with locking and release by painfulmanipulation may result from a trigger finger within thetendon sheath
- Extension contracture- Limitation of flexion (extension contracture)can be caused by tightness in one or more structures on the dorsal aspect of the joint.
- Skin
- Dorsal capsule and collateral ligaments scar
- Shortening or adhesions of extensor tendons and sheath.
- Bone block.
Pre operative management of stiff hand
- Radiograph of hand and fingers are done to assess the condition of bone or the involvement of bone
- All pre operative investigations are done
Management of stiff hand
Non operative management
Non operative management is more effective early on after the injury during the edema phase and subsequent collagen phase of wound healing when fluid can be displaced and collagen remodeled. Once scar and fibrosis have reached maturity, it is less likely to respond to non-operative measures. Non operativemeasures include
- Splinting- It involvesthe application of a non-elastic force in the direction of thedesired correction.
- Other measuresfor edema reduction (by extremity elevation and compressiongloves), moist heat, and ultrasound may enhance thebeneficial response achieved by splinting.
Operative management
- Soft tissue and skin contracture
- Zplasty with transposition of triangular flaps with or without ssg cover
- Joshi homolateral digital flap cover
- Tendon or tendon sheath shortening- by tenolysis, Adhesiolyisis ortendon lengthening procedures
- Any deficienciesin tendon and nerves are corrected
- Joint stiffness- by closed or open capsulotomy
Post operative management
Limb immobilization and elevation
Splinting for about 3 weeks (According to the procedure involved) then active exercises are started
Active Physiotherapy Is the key element in the post operative management. Earlier the better and faster the results.
Stiff Fingers Images
Indivisual results may vary from person to person.
These pictures are shown for the purpose of education only.
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