The Stiff Finger

There are many causes of finger stiffness. Usually finger stiffness is due to previous fracture, ligament injury or surgery. Finger stiffness can be debilitating and may severely impair hand function.

Initial treatment for finger stiffness is hand therapy. A certified hand therapist will be most effective in mobilizing the digit. Therapy is continued for as long as it results in an increase in motion. Occasionally, a steroid injection may be helpful to decrease inflammation and allow therapy to progress.

Once motion ‘plateaus’, ie. stops improving, a decision is made. If finger motion is good enough that the residual stiffness doesn’t cause significant dysfunction, then no further treatment is necessary. On the other hand, if residual stiffness impairs hand function, then a surgical release may be considered.

All other issues should usually be resolved before releasing the joints. Specifically, the bones of the finger should be healed in good position. If they’re not, then they will usually need to be cut and fixed in better position as a ‘first stage’ surgery. If the joints are injured, they will either need to be repaired or reconstructed, if possible, again as a ‘first stage’ surgery. Not every injured joint can be salvaged, in which case joint fusions may be necessary, where the joint is permanently stiffened to decrease pain and increase stability. Following any ‘first stage’ surgery, there is at least a 3-4 month waiting period for inflammation and swelling to end before the surgical release is performed. It’s better to have the release performed within a year of the injury or surgery that led to the stiffness, but that’s not always possible. It’s always easiest if only one finger is involved; the more fingers and the more joints involved, the more difficult it is to ‘focus’ on any particular finger or joint afterwards in therapy, and the more painful the therapy, which can decrease its effectiveness.

Surgical releases of the finger release both the joint and one of the tendons that become scarred down. If both the flexor and extensor tendons are scarred down, they will need to be released at separate operations, again at least 3-4 months apart. Attempts to release both tendons at the same time usually results in failure of the procedure. The extensor tendon and any stiff joints are usually released first and the flexor tendons at a later time, if necessary.

The surgery is an outpatient procedure that is usually very successful and not very painful. However, the main issue is the serious time commitment required after surgery. Therapy usually starts the same day as surgery. Therapy is usually 5 days/week for 4 weeks, then 4 days/week for 4 weeks then 3 days/week for 4 weeks. That’s a big commitment. Some people need less, but that’s not something to count on until after hand therapy is begun and it’s seen how finger motion progresses. The goal is to maintain the motion attained surgically. A home program is performed 7 days/week for many months, often for a year.

In summary, stiff fingers can usually be mobilized and good function regained. But it’s a lot of work, and a big commitment as far as time and effort from the patient. As for most things in life, dedication and persistence are the keys.