Treating finger stiffness post injury
January 4, 2025 10:29 PM Subscribe
Nine months ago I was attacked by a pit bull and suffered, among other things, crush injuries (but not fractures) to several of the knuckles on my hand. I have been in occupational therapy all this time but the fingers are still extremely stiff and painful and I can't make a fully closed fist. I have had frozen shoulder in the past so I assume I have a tendency to fibrosis and that's what's going on in my knuckles. I am praying to the AskMe gods for suggestions of what therapies I might try or what kind of specialist might be able to help me, because the hand surgeons and OTs have nothing more to offer.
Have you done PT? You'd want to seek out a hand therapist specifically.
posted by hoyland at 1:10 AM on January 5 [5 favorites]
posted by hoyland at 1:10 AM on January 5 [5 favorites]
Another rock climber here.
I have a physical therapist who specializes in fingers - he has an echo machine with which he can identify the types of tissue & swelling in fingers.
I would guess hand surgeons have them as well. But for me it really helped understanding what is going on.
I have a thumb that I injured in another accident. I can't bend it as far as the other one, which is annoying but not limiting. He said it's scar tissue and the way to fix it is to stretch 3x a day for a couple of minutes diligently for months to change it even a bit. So he also suggested to me to think about how much I want it.
Good luck!
posted by Thisandthat at 1:14 AM on January 5 [3 favorites]
I have a physical therapist who specializes in fingers - he has an echo machine with which he can identify the types of tissue & swelling in fingers.
I would guess hand surgeons have them as well. But for me it really helped understanding what is going on.
I have a thumb that I injured in another accident. I can't bend it as far as the other one, which is annoying but not limiting. He said it's scar tissue and the way to fix it is to stretch 3x a day for a couple of minutes diligently for months to change it even a bit. So he also suggested to me to think about how much I want it.
Good luck!
posted by Thisandthat at 1:14 AM on January 5 [3 favorites]
IAARN, but NYRN. This is not medical advice.
When you went to the OTs, did they measure your range of motion (ROM) at the beginning and end of your therapy? They should have done this to send progress reports to your surgeon. Was there any indication that you would have a permanent loss of ROM, either from the surgeons or therapists? Dog bites are particularly insidious because of their crush mechanism, and it takes a long time for nerves to grow back (I've had a few).
Adhesions from scars can be a problem, so if you're not massaging (and I mean really *massaging*) the scars a few times a day to break up scar tissue, it would be a good habit to get into. You don't need the therapy goo that was probably used at OT, just a thicker hand cream like Aquaphor. The idea is to mobilize the scar away from the fascia below it. So, back and forth, stretching it, in small circles, etc. It won't feel great initially, but eventually, you will find yourself doing it without even realizing it.
As far as mobilization, have you tried warming up your hands with a heating pad to loosen them up before working on them? My OT had this cool deep box of hot sand I would stick my hand in. The sand blew around inside this huge box for maybe ten minutes and then we started therapy. There should be passive stretching (bending your fingers with your opposite hand), doing a little more than is comfortable, and holding the stretch for just a couple of counts. This really loosens things up and feels better the more you do it. It's something you can do while watching TV or standing in line. Active stretching and strengthening usually involve Theraputty, different hand exercises that I'm sure you already know, etc. OT/PT is **vital**. I know it sucks, it hurts and, it's boring as hell. But without it, you won't regain your original strength/ROM (or as close as possible).
You say that the knuckles are 'among other things'. Well, depending on those 'other things', they may affect your progress. I've had surgery on nine out of ten fingers. I have great ROM in all of them, except one thumb, but it's always been a troublemaker thumb. It also happens to be attached to a wrist previously operated on at least three times. I have somewhat limited ROM on that wrist. I honestly don't notice it most of the time, although I notice the stiffness as I've gotten older.
Finally, when you say this happened nine months ago, yes, the injury occurred nine months ago. But then you had the surgery, and then you were immobilized. On the low end, this was two weeks. On the high end, it could have been twelve weeks. In that period, your muscles and tendons atrophy, and need to wake up. In reality, it's only been maybe six or eight months. That is not a long time at all! Best of luck to you and keep stretching!!
posted by dancinglamb at 4:57 AM on January 5 [12 favorites]
When you went to the OTs, did they measure your range of motion (ROM) at the beginning and end of your therapy? They should have done this to send progress reports to your surgeon. Was there any indication that you would have a permanent loss of ROM, either from the surgeons or therapists? Dog bites are particularly insidious because of their crush mechanism, and it takes a long time for nerves to grow back (I've had a few).
Adhesions from scars can be a problem, so if you're not massaging (and I mean really *massaging*) the scars a few times a day to break up scar tissue, it would be a good habit to get into. You don't need the therapy goo that was probably used at OT, just a thicker hand cream like Aquaphor. The idea is to mobilize the scar away from the fascia below it. So, back and forth, stretching it, in small circles, etc. It won't feel great initially, but eventually, you will find yourself doing it without even realizing it.
As far as mobilization, have you tried warming up your hands with a heating pad to loosen them up before working on them? My OT had this cool deep box of hot sand I would stick my hand in. The sand blew around inside this huge box for maybe ten minutes and then we started therapy. There should be passive stretching (bending your fingers with your opposite hand), doing a little more than is comfortable, and holding the stretch for just a couple of counts. This really loosens things up and feels better the more you do it. It's something you can do while watching TV or standing in line. Active stretching and strengthening usually involve Theraputty, different hand exercises that I'm sure you already know, etc. OT/PT is **vital**. I know it sucks, it hurts and, it's boring as hell. But without it, you won't regain your original strength/ROM (or as close as possible).
You say that the knuckles are 'among other things'. Well, depending on those 'other things', they may affect your progress. I've had surgery on nine out of ten fingers. I have great ROM in all of them, except one thumb, but it's always been a troublemaker thumb. It also happens to be attached to a wrist previously operated on at least three times. I have somewhat limited ROM on that wrist. I honestly don't notice it most of the time, although I notice the stiffness as I've gotten older.
Finally, when you say this happened nine months ago, yes, the injury occurred nine months ago. But then you had the surgery, and then you were immobilized. On the low end, this was two weeks. On the high end, it could have been twelve weeks. In that period, your muscles and tendons atrophy, and need to wake up. In reality, it's only been maybe six or eight months. That is not a long time at all! Best of luck to you and keep stretching!!
posted by dancinglamb at 4:57 AM on January 5 [12 favorites]
I had plantar fasciitis which resolved by using Verapamil gel over a couple of months. You might check that out, I think it could help.
Amusing aside: verapamil is also used to treat Peyroni's disease, so my jar of verapamil is labeled "apply to affected areas of penis twice daily", despite telling the pharmacist several times that's not my use case.
posted by anadem at 8:11 AM on January 5 [2 favorites]
Amusing aside: verapamil is also used to treat Peyroni's disease, so my jar of verapamil is labeled "apply to affected areas of penis twice daily", despite telling the pharmacist several times that's not my use case.
posted by anadem at 8:11 AM on January 5 [2 favorites]
I had minor finger surgery more than a year ago, and while I diligently did all my exercises and soaked it a lot in warm water, and use vitamin E cream on it, some stiffness remains. I think time and diligent OT are the best things. (I’ve also had frozen shoulder, had not considered that I may be prone to fibrosis!)
posted by Lawn Beaver at 11:52 AM on January 5 [1 favorite]
posted by Lawn Beaver at 11:52 AM on January 5 [1 favorite]
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posted by kickingtheground at 12:27 AM on January 5