The Stiff Hand

The term ‘stiff hand’ is often used by health professionals to describe a hand that has reduced passive and active range of motion (ROM). This condition can significantly limit functional performance and can be very detrimental to the persons well being. Therapists and medical practitioners alike work very hard to make sure that stiffness is prevented.
Why do joints stiffen up in the first place?
When a joint is immobilised changes occur in the muscles that surround that joint. The types of changes that occur vary and depend on:
  • The position of immobilisation,
  • The duration of immobilisation and
  • The type of muscles that are affected
Some of the changes that are common include:
  • Muscle atrophy
    • This occurs due to reduction of the normal functional use of the muscle and consequent removal of physical stressors
    • Can occur as quickly as a few days
    • When immobilised in a shortened position the muscle will atrophy quicker than if held in a lengthened position
  • Decreased extensibility of the muscle
    • Due to an increase in the proportion of fibrous tissue and subcutaneous fat in the muscle
  • Adhesion formation within the muscle fibres
    • Due to increased cross linking between disorganised collagen fibres
  • Overall tissue weakness
    • Caused by a number of factors including:
      • Muscle atrophy
      • Removal of physical stressors
      • Disorganised collagen fibres
The hand therapist will never immobilise a joint unless it is needed to allow tissues to heal, such as after a fracture. Luckily they have expert knowledge of the tissues in the hand and arm which they use to limit the effects of immobilisation. Strategies used include:
  • Having a strong knowledge of what needs to be immobilised to protect the damaged tissue which enables them to only immobilise the absolutely necessary joints
  • Knowing the safe position of immobilisation for each joint
  • Prescribing therapeutic exercises for the surrounding joints to encourage muscle length and prevent unnecessary muscle atrophy
In a future post I will discuss treatment strategies for the stiff hand.

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