Procedures · Hand & Upper Extremity Surgery

The Stiff Hand

Medically reviewed by Dr. Khalid Almutairi, Consultant Plastic Surgeon — updated 2026-08-13

A hand that has healed is not always a hand that moves. After fractures, wounds, and surgery, the fingers can stiffen and their range shrink, until the stiffness itself — not the original injury — becomes the problem that disrupts daily life. The good news: stiffness has specific, diagnosable causes, and each cause has a treatment path.

Care is led by Dr. Khalid Almutairi, a consultant plastic and reconstructive surgeon, fellowship trained in hand surgery and microsurgery in Canada and the USA.

Why does a hand stiffen?

Several factors combine to create stiffness, and they often coexist in the same hand:

• Prolonged immobilisation: a joint kept still for a long time shortens its ligaments and capsule.
• Neglected swelling: accumulated fluid organises into fibrous tissue over time and becomes a physical restraint.
• Tendon adhesions: a healed tendon can stick to its surroundings and lose its glide.
• Scar and its contracture: particularly after extensive wounds and burns.
• Damage to the joint itself: after fractures entering the joint, or joint disease.
• Multi-structure injuries: where more than one cause meets in a single finger.

The first question in examination: active or passive?

Examination separates two fundamentally different situations. If the finger cannot move under its own power but the examiner can move it fully by hand, the problem usually lies in the motor apparatus — an adherent or weakened tendon. If the joint itself will not move even passively, the restraint lies in the joint and its capsule, or in scar. This distinction is what determines treatment — and many stiff hands contain a mixture of both.

Treatment always starts without surgery

Specialist hand therapy is the first line: range-of-movement exercises, corrective splints that gradually stretch shortened tissue, swelling management, and scar treatment. Many stiff hands improve substantially on this path alone when it is started early and followed consistently — and prevention beats all of it: moving what can safely be moved early after any injury, according to instructions.

When is surgery considered, and what does it involve?

Surgery is discussed when improvement with therapy has reached its ceiling and a significant, function-limiting restraint remains. The tools are chosen according to the cause:

• Tenolysis: restoring glide to a healed but adherent tendon — provided the joint's passive movement is good.
• Joint and capsular release: dividing shortened ligaments and fibrosed capsule in a joint that will not move passively.
• Scar and contracture correction: by rearrangement or grafting where needed.
• Removal of a mechanical block: such as a bony prominence or fixation hardware obstructing movement.
• Secondary tendon reconstruction: when the tendon itself is beyond salvage — covered on the tendon injury pages.

After release: the gain is kept by movement

The most important part of release surgery comes after it. Early movement — usually within the first days, under a hand therapist — is what preserves the range the surgery gained and prevents adhesions from returning. Surgery and rehabilitation are therefore planned as a single unit from the start, and the patient is told plainly that their adherence is a full partner in the result.

Expectations and limitations

The goal of surgery is to improve range and function; a full return to normal movement cannot be guaranteed — particularly where the joint itself is damaged. Risks include partial recurrence of adhesions, temporary pain and swelling, a wound needing care, and rarely injury to neighbouring structures. In severely damaged joints, the most realistic option may be fusing the joint in a comfortable functional position — or replacing it in selected cases — and this trade-off is discussed frankly.

Is it too late for a hand that has been stiff for years?

Not necessarily. The tissues, joints, and tendons are assessed, and what can realistically be gained is built on that — and sometimes a well-planned partial improvement changes a patient's daily life substantially.

Why not operate straight away instead of months of therapy?

Because surgery on inflamed or swollen tissue breeds more adhesions, and because many hands reach their goal without surgery at all. Surgery is a precise tool used at its right time, not before it.

When does the result of a release appear?

The gained range appears early; consolidating it takes weeks of committed rehabilitation, and function and comfort continue improving afterwards.

Medical-information notice

This is general information and does not replace consultation and examination. Stiffness accompanied by severe escalating pain, colour change, or heat needs urgent assessment.