Stiff Fingers

Stiff fingers may occur following injuries to the hand or wrist. The first-line treatment for this is hand therapy, often using splints with springs or rubber bands on them to stretch out the digits. If therapy fails and the finger stiffness is decreasing hand function, a surgical solution can be considered.

Surgical release is often very effective for stiff fingers, especially to regain flexion/bending. The surgical release is performed in the morning. Therapy begins that afternoon. The therapy is intensive, often 5 days/week for a month, then 4 days/week for a month, then 3 days/week for a month. The surgery is not very painful. The therapy can be painful and it’s often a good idea to take a pain pill before therapy if someone else can drive you there. Most people who work with the therapist and do their homework (ie. performing motion exercises several times a day, every day, on their own) regain excellent finger flexion and excellent hand function.

Obtaining finger extension is also possible, although not as predictable. The proximal interphalangeal (PIP) joint is the joint most commonly ‘stuck’ in flexion. Open surgery is not very effective for regaining PIP joint extension. To regain PIP joint extension, the best way is probably by using a ‘digit widget’. The digit widget is a device that is attached to the middle finger bone by a minor surgery. This surgery doesn’t hurt much at all. The digit widget attaches to a rubber band, which is attached to a removable Velcro glove that goes over the hand. This rubber band places an extension force on the PIP joint 24 hours a day. Therapy is not very intensive, but is performed roughly once a week, in order to check the digit widget’s position and often supplement it with splinting of the adjacent metacarpophalangeal joint (MPJ). The digit widget is left in place for 6 weeks and then removed in the office (which also doesn’t hurt very much). Night splints are worn for 6 months to minimize the chance of recurrence. The digit widget is usually very effective. If you’re interested, you can look up the digit widget on the internet at http://www.handbiolab.com/products/digit-widget/

For all surgical releases, results are best if only one finger is involved. If more than one finger is involved, then the time and attention of therapy is divided, and results may not be as good for each individual digit.

So if you have a stiff finger that is causing hand dysfunction and therapy isn’t working, you should be aware that effective surgical options exist. The surgeries are not very painful. However, the post-operative therapy is very intensive, and time must be set aside in your schedule to attend therapy for the releases to be effective. Hand therapy is a necessary and integral part of the treatment, as is ‘home work’, involving performing motion exercises on your own. As with most surgeries, motivated patients do best.

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