Muscles all over the body have the potential to become stiff and restricted from daily activities. When I evaluate a patient for the first time, I often ask them which of their muscles feel chronically tight. The most common replies are the hamstrings and the muscles of the neck.
Even though we use our hands all day with typing, texting, using a mouse, and countless other activities, the muscles of the hand are often ignored in respect to stretching and maintenance.
Here is a prime example of muscle stiffness in the hand that goes untreated. Can you make an “open fist” like in the photo to the right? Notice that with ideal range, the pads of the fingers are touching the topmost part of the palm while the first knuckles stay totally straight. Think of keeping your hand open so that you could strike something with the palm of your hand.
If the “intrinsic” muscles of the hand become stiff or tight, the finger pads will not touch the palm, or the hand will close in to more of a “closed fist” position. If you find that you do not have full range in this position, it may be a good idea to start gently stretching your hands. You can easily work on all of the fingers at the same time (as shown in the first photo), or you can focus on individual fingers as shown in the following video.
As a guideline to stretching, sharp pain in one finger is an indication that something else might be wrong. For instance, if one of your fingers does not move into the stretch position while the other fingers do, it may be possible that one of the knuckles in the finger may be jammed or otherwise traumatized. In these cases it is wise to see a doctor who specializes in hand injuries who can isolate the problem.
My question is not related to finger movement, it involves my 16 year old daughter’s wrist. For the past year she has struggled with ulnar side wrist pain. She can’t lift weights, do push-ups, or anything else that loads her wrist. She has a lot of pain over her lunate bone, and it is nearly impossible for her to supinate her wrist. She had an MRI 6 months ago with the findings: dorsal ganglion cyst, negative ulnar variance, marrow abnormality at triquetrum and ulnar styloid process, and ulnar styloid impingement. She has worn casts for 12 weeks in the past 6 months and had great improvement, but recently it became very problematic again with a noticeable increase in size of the ganglion cyst. Is there anything that she can do to get permanent relief? She is an active athlete and is basically not able to do upper body strengthening because of this.
That is a tough one. Dorsal ganglion cysts are a real pain to deal with, especially when the wrist is placed in end-range extension. Push-ups and pressing motions will often compress the cyst, inflame it,and in many cases cause it to fill up with more fluid. Stack on top of that the ulnar styloid impingement, and we have a wrist that probably won’t handle full extension well.
If that were my wrist, I would totally avoid placing the wrist in end-range extension. That is sort of limiting, but it is doable. That would mean no push-ups, no downward dogs, etc.. The other option would be surgery to excise the cyst and perhaps slightly shave down the ulnar styloid???
One other thought here, loss of supination is typically not the result of a dorsal cyst. Supination loss is more the result of an imperfect relationship in the lengths of the distal radius and ulna. If the two bones are not aligned well, it becomes harder to supinate. We usually see this phenomenon with fractured radius bones that heal back either slightly longer or slightly shorter. So…………it might be possible that the ulnar styloid variance is causing the loss of supination.
I wish I could give you good advice here, but it is more complicated that what I can advice based on what you told me. If your daughter refuses to avoid the positioning limitations that I suggested because of sports and general life requirements, it might be a good idea to get a surgical consult from an orthopedist who specializes in hands.
Thank you for the advice. I think we will probably look for an orthopedic surgeon to see what they say. The ganglion cyst is very prominent and hard, right above her lunate. Whereas it used to seem much softer and fluid filled. My daughter had a Salter-Harris fracture to that wrist when she was 11. Is it possible that the negative ulnar variance is a result of that injury? The doctor she saw before was not an orthopedic surgeon, but he thought she may be in the early stages of Kienbock’s disease. Would the cyst now being over her lunate put her at a greater risk for Kienbocks?
I don’t think that the cyst predisposes someone for Kienbock’s disease. A fracture on the other hand might, simply because the trauma from the fall may have effected the carpal bones in addition to fracturing the forearm.
Growth plate fractures by the way can easily account for the loss of supination that your daughter has. A Salter-Harris fracture can have the effect of changing the growth rate of the effected bone. This can cause the problem that I mentioned in my last response (the lengths of the radius and ulna).
Hello,I have had surgery for tennis elbow surgery 5 months ago after having tennis elbow for 6 months.now its been a year of pain my arm is worse than before surgery I cant do my hair,button my pants,eat grip things carry things etc without pain.mt arm bends about 70 percent and straighten about the same..is there anything I can do to stop the everyday pain and straighten and bend my arm…
That sounds like a difficult situation. I would see a PT if you have not already. I will typically have the patient wear a wrist immobilizer brace for several weeks to allow some healing to occur prior to starting any exercises or stretching.
I have always been completely healthy and normal, 33 years old and live a active healthy lifestyle. 3 months ago I came down with trigged thumb and from there everyday both hands got worse. I went from having carpal tunnel symptoms to now having cubital tunnel symptoms constantly. my hands a very weak and have a hard time making a full fist without my fingers feeling crammed too tightly together. The biggest issue for me has been my pinky knuckle on both hands. it happens way worse at night or when I’ve been relaxing but when I got to make a fist it feels like my knuckle is so tight it bounces from one position to another no smooth gliding. and sometimes in my sleep it wakes me because it feels like my pinky knuckle collapses. It isn’t painful or throbbing just feels very tight and almost deformed when this happens. Do you know what this could be?
Kim these symptoms are a bit strange, but my first thought is that this might be the result of repetitive over-use (typing or working with your hands all day). At the very least you should consult a PT/OT hand therapist in person to get to the bottom of what is going on.
This sounds like the result of repetitive over-use? This could have come from typing or using your hands aggressively all day. It is also possible that this might be something rheumatoid maybe (like rheumatoid arthritis)? I would at the very least see your MD and get a PT eval with a hand therapist to get to the bottom of what is going on.
I’m a 22 year old digital artist whose currently in my third year of college. Because of the nature of both my work and my study, I have to draw and type a lot. Recently, I’ve noticed that my fingers seem to get slow and stiff as I’m working. It doesn’t even take that long, maybe 10 minutes before my fingers start tripping over letters on the keyboard. There’s also a lot of discomfort, not really pain but it doesn’t feel good, and a bit of numbness in the fingertips. I know you can’t give a diagnosis or anything, but do you have any suggestions (besides talking to my doctor) for some way to restore some sort of function to my hands? It’s starting to get in the way of my assignments.