Ep 39: Hand and Wrist Stiffness? Exercises for Recovery After Injury or Surgery

Stiffness in the hand, wrist, and forearm commonly occurs after injuries, surgeries, or immobilization, and requires specific rehabilitation techniques to restore healthy movement. Understanding the science behind tissue recovery and proper stretching techniques leads to better outcomes and less pain during the rehabilitation process.

• Stiffness happens quickly when joints, soft tissues, tendons, and muscles contract during healing
• Living tissues need rest periods between stretches—constant motion actually increases inflammation
• Pushing too hard causes a stretch reflex where tissues contract more, worsening stiffness
• Post-surgery motion typically begins within a week for fractures fixed with plates and screws
• Specific stretches include forearm rotation, wrist flexion/extension, and finger mobility exercises
• Elevate hand above heart level to reduce swelling (hand on chest while walking, pillows while seated)
• Post-cast rehabilitation requires active-assisted range of motion with light, sustained stretches
• Perform stretches every 2-3 hours, holding for 10-20 seconds, followed by a 3-second active hold
• Understanding wrist-finger mechanics helps target specific tendons and muscles
• Recording personalized stretching routines on your phone provides an easy reference for home exercises

Thank you for watching, subscribing, and sharing these videos with people experiencing stiffness, pain, or limited use of their arm.

Chapters

• 0:00 Introduction to Hand Stiffness Issues
• 1:24 Post-Surgery Motion Techniques
• 3:38 Strategies for Swelling Reduction
• 4:50 Post-Cast Recovery Methods
• 7:19 Wrist Mechanics and Stretching Techniques
• 10:35 Final Recommendations and Closing

Transcript

Speaker 1: 0:00

Welcome back to the Hand-to-Shoulder Solution Giving Pain the Middle Finger. Thank you for liking and for subscribing, and also thank you for sharing these videos with people who you might know are experiencing stiffness, pain, lack of use of their arm. This is great information. What I'm working on doing is providing you with shorter, more concise videos so you can take pieces of information and use those to your benefit. Again, this isn't treatment or treatment advice. This is information sharing to empower you to realize when and where you need to go to get the services that you need.

Speaker 1: 0:33

As an occupational therapist and a board-certified hand therapist, I work to rehabilitate orthopedic conditions affecting the fingertips through the shoulder. Today, I want to talk about stiffness. There's a lot of reasons for stiffness. Whether a person just got out of a cast, perhaps they just had a fracture or a broken bone, or they just had to have surgery to repair tendons and or nerves, or they had an injury and they've just been learning to use their hand a little bit less while they are healing, to use their hand a little bit less while they are healing. Stiffness can occur quickly and it can be very frustrating for people to regain their movement. Also, what happens when the joints and the soft tissues, like the skin and the tendons, which connect muscle to bone, and the muscles themselves, and also scar tissue contracts. It shrinks and tightens when they get to their end range of motion. It sometimes can be very painful as well.

Speaker 1: 1:32

In the clinic we teach people very specific techniques for restoring the range of motion so that the range of motion is being done safely and most efficiently is being done safely and most efficiently. Also, I always stress to patients that the range of motion cannot be done continuously. So a lot of patients will come into the clinic and they're just, you know, they're attempting to keep it loose and they're moving all the time. They're always trying to loosen it up and the assumption often is that more is better. However, we're dealing with living tissue and it's this living tissue that has to be given the opportunity to rest. It's sort of like watering plants you have to water the plants, but you can't water them all day long. The rest period is as important as the exercise or the stretches or anything that's being done. Otherwise, you're going to increase inflammation, increase pain and actually make it more stiff. Also with stretches, if you push, if you push too hard remember this is living tissue if you push too hard on the tissues, the tissues go into what's called a stretch reflex and they actually pull back, they actually contract and that will actually increase the stiffness. So some basic stretches. So let's say, let's talk about a fracture the end of the radius bone.

Speaker 1: 2:51

When somebody falls on an outstretched hand and this was a recent video that I did and this fractures and a person needs surgery. If the person has a surgery with plates and screws, I usually start moving these folks within about a week after surgery, one week and we do very gentle, active motion where the patient is moving on their own and there are certain positions where it puts less stress on the bones. So as the elbow bends and they turn their hand palm facing, palm up or palm facing them, that's an easier way to turn the hand, palm up, reaching out and turning a palm down, which, if I think about it, that's a normal action because we reach for things. We turn our hand palm down. So elbow extension, straightening the elbow, turning it palm down, and that's reintroducing motion Remember, this is about a week after surgery and then stabilizing below the wrist and flexing and extending. So normal mechanics is when you bend the wrist down, the fingers extend or they straighten. When it comes up, the fingers flex or they bend, so straighten, bend, straighten, straighten, bend and then side to side. So I tell patients the wrist moves think of a plus sign goes down and up and also side to side. And then to reduce swelling, I'll have patients bring their hand right up above their head. I tell them to look at their hand, slowly, close and open their fist and just start with about 12 of those. If you, you know, if you're swollen, the best way to to to keep it elevated is keep your hand above your heart. So when you're walking, if you just bend your elbow, lay your hand on your chest. That keeps your hand above your heart. Super easy. When I tell my patients, when they're watching TV and they're sitting down, you stack up some bed pillows on the armrest and just have the hand up here above their heart. When they're in bed, the whole body is horizontal. I tell them just be comfortable, get some sleep.

Speaker 1: 4:41

More often than not I have them in a custom brace that they can wear to stabilize any fractures or any problems that they're having. Now let's say a patient just got out of a cast. Let's say they had a fracture or a broken bone and they did not need surgery. And now it's been immobilized for six weeks. That's a long time, a month and a half of immobilization, which needs to be done. The fracture now is healed.

Speaker 1: 5:06

Now they get out of the cast. We need to get them moving. So there's something called active assisted range of motion where if, say, for example, the patient can't turn their hand palm up, I'll have them activate the correct muscles while they use what's called a clamp grip and they get here at the end of the forearm, because that's where the it's the forearm bone. People are usually surprised to see this. When you turn a palm down, the radius is now flipped over the top of the ulna. When you turn a palm up, the radius is now parallel with the ulna. Palm down, palm up, and that's happening in the forearm joint, that forearm muscle. There's a thick, heavy ligament between these two bones. When that shrinks up too much, it's almost impossible to regain the range of motion.

Speaker 1: 5:49

So, right, when they get out of the cast, we get the person moving and I'll have them stretch, usually every two to three hours. So every two hours is roughly six times a day. Every three hours is roughly four times per day. So here's the technique. I'll then turn it palm up. While they're working on using their own muscle power to turn it palm up, they come in with a clamp grip right here and they're turning it like that until they feel a light stretch, just like when you touch your toes and you feel it pulling your hamstrings. That's a pulling sensation. You just want to go to that. You don't want to cause pain. If you're causing pain, you're just being too aggressive. It's going to increase inflammation, it's going to cause other problems and perhaps also make it even more stiff. So you're going to hold it for about 10 or 20 seconds, then end. Watch this, this is clever. You end with a place and hold exercise. So after the stretch you hold it for three, one and two and three and then relax. That gets the muscles pulling to the end range of motion. That retrains the muscles. So your active muscle control matches your flexibility as you regain flexibility. So that's one technique.

Speaker 1: 6:53

Another thing turning a palm down. That's tough too. So I'll have patients just go over the top. So they're grabbing there ulna here and I show them on the model in the office. They grab their ulna and then then they push the radius bone down and they're, and they're stretching it down in that manner. So here you go, over the top, they're grabbing the pinky side of the forearm and then pushing down with the heel of their palm on the back side of the radius bone. They're turning their palm down again, they're holding a stretch 10 or 20 seconds place and hold for three seconds and relax. They do two rounds of that every two or three hours. Some patients, for various reasons, all of them only do it three times per day. Other patients every two to three hours, and I write this out. More often than not, what I do is use a patient's cell phone. They take a video of their stretches with their cell phone so they can reference it later.

Speaker 1: 7:46

Now the wrist the wrist gets, you know, everything gets really tight. There's so many ligaments which connect bone to bone. There's so many tendons which connect muscle to bone. There's 24 ligaments in the wrist. There's 24 tendons connecting the muscles to the bone that go across the wrist. So there's a lot going on. So a lot of times, what a lot of people do is lean their elbow into their thigh, palm down over the top of the knee, and then they bend their wrist down and then just push on the back of their hand and let the fingers be free. That's a separate stretch to stretch these long finger extensors.

Speaker 1: 8:17

But let's just talk about the wrist joints. Okay, so you're resting the tip of the elbow into the thigh, you're bending the hand down and pushing on the back of the wrist, and then another one is to flip it over, because it has to go the other way too and go over the knee. Some people prefer to go over the edge of a table. Um, there's various techniques. Now, when people have a hard time turning a palm up or turning a palm down, I'll have them use the side of the knee so they can come in here on the side of the thigh, go around the knee and push here. So fingers are always out straight when you're stretching the wrist. Okay, so when you're coming back and pushing it like this and then toward the palm on the outside of the knee, come here and bend that wrist. Now watch this.

Speaker 1: 9:03

Here's some basic mechanics of the wrist and fingers. So the muscles that do this are here. The muscles that do this are here. The muscles that do this are here on the back. The muscles that do this are here on the back. The tendons cross the wrist, so think of it like a pulley system, almost. So if I just let my hand flap down like this, my fingers automatically straighten, because now these tendons which connect the muscles to the bone that go to the fingers are pulled tight because they're pulled around the back of the wrist.

Speaker 1: 9:35

Okay, now, when I flop it back this way, my fingers naturally bend.

Speaker 1: 9:41

And because now they're pulled taut over the front of the wrist.

Speaker 1: 9:46

Now if I want to stretch those tendons because if I look at the, I always compare it to the opposite side in the clinic so I'll make a fist and then this side bends that much because those tendons connecting these muscles to the tips of the fingers are flexible like they should be Now after the patient's been in a cast for quite a while, and then they bend this side oh, that is really tight.

Speaker 1: 10:11

So I'll just simply grab their fist and bend it down to a light, sustained stretch and then a lot of times coming back like this. That'll be nice and flexible, and then this pretty stiff, and that's where this one is being involved in the stretch that I showed you previously. Anyway, so these things need to be taken into consideration. It's very important that you be seen by a hand therapist that can thoroughly assess this and then give you the most optimal stretches for you, and what I like to do in the clinic, as I mentioned, is use the patient's telephone to do a video on their phone so they can reference their stretches. Thank you very much for watching, thank you for sharing this, thank you for supporting the channel, thank you for subscribing.