Stiff Fingers, Simple Fixes

Chapters

• 0:02 Welcome And Scope Of Topic
• 0:19 Why Fingers Get Stiff
• 1:25 Start Early With Guided Motion
• 2:36 Anatomy Of Knuckles And Creases
• 3:23 Big Knuckle Flexion Technique
• 4:11 Middle And End Joint Stretching
• 4:50 Thumb Flexion And Opposition
• 6:08 Active Holds To Retrain Muscles
• 6:32 Home Taping For Progressive Stretch
• 7:42 Composite Fist And Progression
• 8:40 Frequency, Monitoring, And Safety
• 9:10 Resources And Closing

Transcript

SPEAKER_00: 0:02

Welcome back to the hand to shoulder solution, giving pain the middle finger. I'm your host, Carl Petito. I'm an occupational therapist and a board certified hand therapist specializing in treating rehabilitating orthopedic conditions affecting the fingertips through the shoulder. Today I want to talk about stiff fingers, and I first want to mention that this is not treatment or treatment advice. This is information sharing so that you can have a keen awareness of what might be going on with your body. I want to show you how to stretch fingers, some things that we do in the clinic that you might anticipate experiencing when you go see your hand therapist, and some things that I have my patients do at home. You know, this channel has been a very good resource for physicians, physician assistants, nurse practitioners, other healthcare providers to perhaps somebody doesn't need skilled outpatient therapy, but they can give them this video to watch and learn how to, for example, this episode, how to stretch your fingers and regain their movement. So arthritis causes stiffness, fractures during and after the fracture healing or the broken bone healing, the fingers become very, very stiff. And as a side note, we actually start stretching fingers in the clinic before the fracture or the broken bone is fully healed. It's very, very important to use special techniques from a skilled professional in the clinic to start to restore that range of motion sooner rather than later because of the very unforgiving nature of all the connective tissue around all of the joints of the fingers. There is a lot of moving parts packed into a very, very tight area. Then if you start adding inflammation, swelling, scar tissue, also if you when you take a look at the joints, every joint or hinge in the fingers, they're surrounded by a capsule of ligamentous material. So if you take this, if you take this and and wrap it with plastic wrap several times or packaging tape several times, that's sort of like the capsule, and the and the capsule shrinks up. So in summary, it's very, very important to start early in range of motion. But once again, you have to be seen by a healthcare professional. And if you're already at the point where you know that you have to stretch your fingers, I'm going to show you some good techniques right now. So, firstly, let's just look at a couple of basic things, okay? The big knuckles right here, they bend at this crease. It's called the distal palmer crease. It looks like they they should bend here at this crease, but it's very important to know that they do not bend there. That's just a relief area where the soft tissues can congregate, it just makes room for the bulky soft tissues. Now, this crease right there is where they bend. So let's start. I usually have my patients start with bending the big knuckles and then going down to the smaller ones. So the big knuckle, you would put your opposite thumb just below that crease, and then your other finger on the back of that first bone. So you're bending that down just like that. And see how I'm keeping these out of the way for the camera? That's what you don't want to do when you're doing the stretcher. So, what it should look like is this all of them going together. Why is that? They're tethered in the back, so these tendons are connected to these muscles. So when these muscles contract, your fingers open, but they're connected side to side. So there's a tethering effect. So if I'm keeping these up out of the way and trying to push this one down, these are limiting this one from moving. So, in other words, they all have to go together as a team, okay? So they drop down as a team, you're gonna go here and bend that and bend that big knuckle and push it down. 10 to 20 seconds, you're gonna hold that for a stretch, not pain, and a pulling sensation. So a stretching pulling sensation. The next one, you're just simply gonna slide up, and now it's this hinge, this middle knuckle is going to bend. You let them all go together as a team. That comes down, and then you go on the end of that bone, the next one for leverage, and you're gonna push that down, okay? And let's do let's do a different angle. Let's do this index finger. You can go go around here, and then you're gonna push that middle hinge down until you feel a stretch. Hold that for 10 to 20 seconds, and then you relax, maybe one more time, and then you're gonna end with the last knuckle, you push that down. Whatever's more comfortable for you, whatever position you want to be in, push that down. The thumb, you have this knuckle right here, this big knuckle here. You can put a finger in that meaty pad right here, it's all the thanar eminence, and then you're gonna bend the hinge. So when the thumb flexes, the tip of the thumb is going down toward the base of the little finger. You just try that on yourself. That's full thumb flexion. We also need to oppose to each one of these other fingers. And by the way, you know, if you look at a raccoon or another other animal that has fingers, they don't have opposable thumbs, and that's what gives us function in our day is our opposable thumbs. Now, you start with this first knuckle, and then you go to the last knuckle. On the thumb, there's there's three joints at the at the wrist. We'll talk about that in another episode. Um, but let's do this one, this hinge, and then that hinge right there. And then full thumb flexion since we're on the thumb is to the base of the small finger. You can push that right down and just hold that steady 20 seconds, a couple of repetitions, and then slowly let go and hold that position. So we call that an active hold. So you hold one and two and three and relax. What does that do? That activates the muscle that does that motion. So the reason why I have people do that is to retrain the muscle to pull down to its end of its flexibility. If we don't do that, then you say, Okay, well, great, I have flexibility, I can push it, I can push it with the other hand, but then when I go to do it on my own, it doesn't go all the way. So the muscle hasn't been retrained because the muscle has been unaccustomed to moving that far because it's been stiff for so long. Now, here's another nice technique that I I have people do at home is you'll take one piece of tape and put on the tip of the thumb and pull it down again, aiming toward the base of the small finger, and tape it on the back of the hand, fold a little piece, and that would be sitting there under stretch with maybe a little heating pad on, and we do this over a period of 20 minutes, and then as the stretch decreases, pull it down a hair, and typically people would advance that by an eighth of an inch, quarter inch every five or ten minutes as the stretch decreases. The stretching sensation is decreasing because your flexibility is increasing. I will also have people do it do another piece of tape frequently, they would go over the tip and then reinforce it, reinforce it over the back of the thumb to really get this knuckle a little bit better, and then they could grab both and advance them over the 20-minute period. Let's go back to the fingers. So after you stretch each individual finger joint, middle one, remember they all go as a team, and the last one, 20 seconds each. That's individual flexion of the joints. Now let's do composite, meaning they're all going together. And that composite flexion is simply a full fist. So you're gonna make sure that you're gonna use one your finger on the back of the first bone to push that big knuckle bent, bent is flexion, you're gonna hold that and then get on the tip of it and push that in. Now your starting point might be all right, there I feel a firm stretch. I'm gonna hold that there for 20 seconds, and then slowly let go. There's my active hold, one and two, and three, then I relax. Then one more round of that, then it's you know, maybe it's starting here, and I'm okay. I feel a stretch there, and then I'm pulling it down, okay. 20 seconds, active hold, one and two, and three. Eventually, it would come down all the way. Usually, I'll have people do those stretches every two hours. We figure a 12-hour waking cycle every two hours is about six times per day. And then, you know, I always ask folks to just pay attention to your symptoms, listen to your body. If it gets sore, being too aggressive, be less aggressive, and maybe go every three hours to decrease your frequency of the stretches. So those are the techniques. Uh, you gotta go easy, be careful. Feel free to share this information with anyone else you know who is dealing with this uh challenge. Check out my website, carlpatito.com. Thank you very much for watching, liking and subscribing.