20 Jan Understanding stiff fingers
Anatomy of the fingers, the biomechanics behind stiff fingers, and the role hand therapy plays in rehabilitation.
As hand therapists, we spend a significant amount of time helping patients recover from injuries, surgeries, and conditions that affect the function of the hand. One common complaint we encounter is stiff fingers, which can range from mild discomfort to complete loss of mobility.
The anatomy of the finger
The fingers are intricate structures made up of bones, joints, tendons, ligaments, muscles, and nerves, all working in harmony to provide mobility, strength, and dexterity. Here’s a breakdown of key anatomical components:
Bones:
Each finger consists of three bones—phalanxes—except for the thumb, which has two. These bones are connected by joints, including the proximal interphalangeal joint (PIP) and distal interphalangeal joint (DIP) as well as the metacarpophalangeal joint (MCP: at the base of the fingers. These joints allow flexion, extension, and some degree of rotation.
Tendons:
Tendons are the tissues that connect muscles to bones. In the fingers, tendons are responsible for movement. The flexor tendons on the palm side enable bending (flexion), while the extensor tendons on the back of the hand allow straightening (extension) of the fingers. The balance between these tendons is essential for fluid, coordinated finger movement.
Ligaments:
Ligaments are tough, fibrous tissues that connect bones to other bones and stabilise joints. In the fingers, ligaments prevent excessive movement and keep the joints aligned.
Muscles:
The muscles that move the fingers are located in the forearm and the hand. The extrinsic muscles (those located in the forearm) control gross motor movements, while the intrinsic muscles (located within the hand) control fine motor skills, such as grasping and precision.
Nerves:
The median ulnar, and radial nerves control both sensation and motor function in the hand. These nerves help you feel textures, temperature, and pressure, and they also coordinate finger movements.
Joints:
The joints are the key areas where finger stiffness can occur. The three primary joints in each finger (except the thumb) are the MCP, PIP, and DIP joints. These joints have synovial fluid that lubricates movement and helps reduce friction. Stiffness can arise if the synovial fluid is reduced, or if inflammation or injury affects the joint capsule.
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Causes of stiff fingers
Now that we understand the anatomy of the fingers, let’s explore some common causes of stiffness:
1. Arthritis
Arthritis, particularly osteoarthritis and rheumatoid arthritis is one of the most common causes of finger stiffness.
- Osteoarthritis occurs when the cartilage that cushions the joints breaks down over time, leading to bone-on-bone contact, pain, and inflammation.
- Rheumatoid arthritis is an autoimmune condition that causes the body’s immune system to attack the joints, leading to chronic inflammation, swelling, and stiffness.
In both cases, the synovial fluid that normally lubricates the joints can become reduced or thicker, leading to friction and pain.
2. Tendon Injuries
The flexor and extensor tendons play a crucial role in finger movement. Injuries to these tendons, whether from trauma, overuse, or inflammation (tendonitis) can lead to stiffness. Tendon injuries might cause:
- Scar tissue formation which restricts the smooth gliding of tendons.
- Adhesions between the tendon and surrounding tissue, making it difficult for the tendon to move through its full range.
3. Joint Contractures
A joint contracture occurs when the tissues around a joint become tight or shortened, limiting movement. This can be caused by:
- Scar tissue after an injury or surgery
- Prolonged immobilisation (such as wearing a cast/excessive splinting)
- Inflammation from conditions like arthritis or rheumatoid arthritis
In hand therapy, joint contractures are a significant source of stiffness. They restrict movement, reduce function, and often lead to deformities if left untreated.
4. Nerve Compression
Nerve compression, such as in carpal tunnel syndrome or cubital tunnel syndrome, can lead to stiffness in the fingers. When nerves like the median nerve are compressed at the wrist (in carpal tunnel syndrome), or the ulnar nerve is compressed at the elbow, the fingers can feel stiff, weak, and even numb.
5. Inactivity or Immobilisation
When fingers or joints are immobilised for a prolonged period—such as after surgery, injury, or during recovery from illness—the soft tissues around the joint can stiffen. This is particularly common after a cast is removed or following surgical procedures like tendon repairs.
How Hand Therapy helps with finger stiffness
Hand therapy is an essential part of rehabilitation for finger stiffness, helping to restore mobility, strength, and function. Here are some of the key treatment methods used by hand therapists:
Manual therapy
Manual therapy involves hands-on techniques to manipulate and mobilise the joints and soft tissues. For stiff fingers, therapists use gentle joint mobilisations to restore the natural movement of the finger joints. They may also apply soft tissue mobilisation to break down adhesions in the tendons and surrounding tissues.
Stretching and strengthening exercises
Finger stiffness often results from tight or weakened muscles and tendons. Hand therapists prescribe specific stretching and strengthening exercises to improve flexibility and strength. For example:
- Tendon gliding exercises help improve the sliding of tendons through their sheaths, promoting smoother movement.
- Active range-of-motion exercises help increase flexibility by gently stretching the finger joints.
- Strengthening exercises use resistance to build strength in the muscles and tendons that control finger movement.
Splinting
In some cases, hand therapists will create custom splints to protect the finger joints, prevent further deformity, or assist with proper alignment. Splints can be used to:
- Rest the joints and tendons while they heal
- Prevent excessive movement that may worsen a contracture
- Provide stability and protection after an injury or surgery
Modalities (heat and cold therapy)
Therapists often use thermal modalities such as heat or cold to help manage stiffness:
- Heat therapy helps to increase blood flow, relax tight muscles, and ease joint stiffness.
Education and ergonomics
Hand therapists educate patients on proper posture, ergonomics, and body mechanics to prevent further strain on the hands and fingers. They may recommend modifications to daily activities or work environments to reduce repetitive stress on the fingers and promote healthy movement patterns.
Finger stiffness is a multifaceted issue that can be caused by a variety of conditions, from arthritis and tendon injuries to nerve compression and inactivity. As hand therapists, we understand the complex anatomy of the fingers and the delicate balance required to restore movement and function. Through targeted interventions such as manual therapy, exercises, splinting, and education, we help patients regain full range of motion and alleviate discomfort.
If you’re experiencing stiff fingers, it’s important to seek the guidance from one of our trained hand therapists who can assess your condition and create a personalised treatment plan. Early intervention can prevent long-term damage and improve your quality of life, allowing you to return to the activities you enjoy.
If you are experiencing finger, hand, wrist or shoulder pain, don’t hesitate to get in touch. We’d love to help you.
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