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Contracture & Stiff Finger Release

Contracture & Stiff Finger Release

The hand and fingers are essential for nearly every activity of daily life, from holding objects to writing and performing delicate tasks. When a finger becomes stiff or develops a contracture (permanent tightening of soft tissues leading to bending or restriction of movement), it significantly affects hand function, strength, and dexterity. Surgical procedures such as contracture release and stiff finger release are performed to restore mobility, reduce pain, and improve functional use of the hand.

Understanding Finger Contractures and Stiffness

1. Contracture

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  • A contracture occurs when the skin, tendons, ligaments, joint capsule, or other soft tissues around the finger become shortened or scarred, pulling the finger into a fixed bent or abnormal position.
  • Causes include trauma, burns, Dupuytren’s contracture, untreated fractures, prolonged immobilization, or neurological conditions.

2. Stiff Finger

  • Stiffness may result from joint disease (such as arthritis), tendon adhesions, previous surgery, infection, or chronic inflammation.
  • The finger may not fully bend or straighten, limiting both power grip and fine motor function.

Common Causes

  • Post-traumatic: Scarring after fractures, tendon injuries, or crush injuries.
  • Burn injuries: Leading to skin tightening and joint contracture.
  • Dupuytren’s Disease: A progressive condition where thickened tissue in the palm pulls the fingers into flexion.
  • Arthritis: Joint stiffness due to cartilage damage and inflammation.
  • Prolonged immobilization: Following splinting or casting.
  • Infections: Such as septic arthritis or deep abscesses causing scarring.

Indications for Release Surgery

Surgical contracture or stiff finger release is considered when:

  • Conservative treatments (physiotherapy, splints, medications) fail to restore motion.
  • The finger remains significantly bent or stiff, interfering with daily tasks.
  • Pain and discomfort are persistent.
  • Functional grip and dexterity are lost.
  • Cosmetic appearance causes psychological concerns.

Surgical Techniques

The specific method of release depends on the underlying cause and severity:

1. Skin Contracture Release

  • Performed in burn-related or scar contractures.
  • The tight scar tissue is excised, and skin coverage is restored using skin grafts or local flaps.

2. Capsulotomy (Joint Release)

  • Tightened joint capsules are surgically cut and released.
  • Often used in post-traumatic stiffness or arthritis-related cases.

3. Tendon Release / Tenolysis

  • Adhesions binding tendons to surrounding tissues are removed.
  • Allows smoother tendon gliding and improves movement.

4. Fasciectomy or Needle Aponeurotomy (Dupuytren’s Disease)

  • Thickened cords of tissue in the palm are excised or divided.
  • Restores finger extension.

5. Arthrolysis

  • Surgical loosening of a stiff joint by removing scar tissue inside and around the joint.

6. Z-plasty or Flap Reconstruction

  • Advanced plastic surgery techniques used when skin shortage contributes to contracture.

These procedures may be performed under regional or general anesthesia and are often combined with intraoperative physiotherapy to assess range of motion immediately.

Benefits of Contracture & Stiff Finger Release

  • Restores range of motion and flexibility.
  • Improves grip strength and overall hand function.
  • Reduces pain and discomfort.
  • Enhances cosmetic appearance of the hand.
  • Prevents further disability and dependence on others for daily activities.
  • Improves quality of life and confidence.

Risks and Complications

Like any surgery, contracture and stiff finger release carry some risks:

  • Recurrence of contracture, particularly in Dupuytren’s disease.
  • Infection or delayed wound healing.
  • Nerve or blood vessel injury.
  • Residual stiffness despite surgery.
  • Scar formation or hypertrophic scars.
  • Rarely, joint instability or weakness.

With proper surgical technique and adherence to rehabilitation, most patients achieve significant improvement.

Importance of Early Intervention

Long-standing contractures and stiffness are more difficult to treat due to irreversible joint changes and muscle atrophy. Early surgical release offers better outcomes, especially when combined with physiotherapy and preventive measures such as splinting and scar care.

Conclusion

Contracture and stiff finger release are vital surgical procedures aimed at restoring mobility, function, and appearance in patients whose hands are restricted by scarring, trauma, or disease. While conservative treatments are always considered first, surgery becomes essential when deformity or stiffness severely impairs daily activities. Modern surgical techniques, combined with structured postoperative rehabilitation, provide excellent outcomes. Timely intervention not only restores hand function but also helps patients regain independence, confidence, and quality of life.

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