Guide to Treating Clenched Fists After Stroke

After a stroke, it is common to experience stiff hands. For some survivors, the hands curl inward, and it may seem nearly impossible to open them. Fortunately, there are ways to relax clenched fists.

 In this article, we’ll go over some of the reasons why hands become clenched post-stroke, and ways to improve hand function.

What Can Cause Clenched Fists?

There are several different causes of tight, clenched hands after a stroke. Oftentimes, after a stroke an individual will have limited or no movement in their hand. It is this lack of movement that leads to soft tissue shortening and can lead to spasticity or even, eventually, a contracture.

Spasticity refers to stiff, tight muscles or muscle spasms that make hand use difficult and even painful.

 Contracture refers to the loss of motion over time that occurs in chronically spastic muscle tissue. When the affected body part cannot move normally, the tendons, muscles, and ligaments become shortened, which further restricts mobility and leads to pain and stiffness. The muscles in the affected area eventually contract or clench, which causes even more pain.

 The underlying problem that causes both spasticity and contracture is damaged communication between the brain and the muscles. When the area of the brain that controls muscle movement has been injured by a stroke, it struggles to send the correct signals to the muscles, including the signal to relax.  This impairment causes muscles to become spastic, tight, and painful.

Temporary and Permanent Treatments For Clenched Fists

Treatments for spasticity and contracture have changed quite a bit over the past couple of decades. New research has led to more effective treatments, which can bring both temporary and permanent relief.

Temporary treatments for spasticity are a common course of action after a stroke. Many stroke patients choose to pursue short-term relief through temporary treatments while also working on more permanent solutions for dealing with clenched fists. It’s important to remember that there’s nothing wrong with making use of these temporary fixes. In fact, because permanent stroke rehabilitation requires consistent work and dedication over a period of time, any measure that makes treatment more comfortable and less daunting can make a positive impact on a patient’s ultimate recovery.

 Botox Helps Provide Short-Term Relief

If you suffer from spasticity, Botox might help. These treatments involve injections of Botox into targeted muscles. While it’s true that Botox is a neurotoxin, in the correct dosage it can work as a nerve block, allowing the muscles to relax, lessening pain and restoring hand functioning.

Botox can take between two and four weeks to take full effect, and it is only a temporary solution. After the treatment wears off, the spasticity will return, so repeated treatments are needed. Botox is great for short-term relief, but it should be combined with longer-term treatments and therapies for the best results.

If spasticity is an issue for a survivor after stroke, their doctor can prescribe or recommend medications to help manage it. Benzodiazepines and muscle relaxers are effective at calming the central nervous system, which will relax muscles. A commonly prescribed CNS agent is baclofen, which works to decrease muscle spasms, tightness, and pain, while improving range of motion. Drugs like Dantrolene address the signals in skeletal muscles that cause contraction, without the incoordination or “loopiness” from benzodiazepines or muscle relaxers. Some doctors will also, depending on the patient’s needs, prescribe hypertension drugs like Clonidine, for a similar effect on contracted muscles.

Stretching and Mobility Are the Key to Long-Term Results to Managing Spasticity

If the muscles in your hand are tight and stiff from spasticity, you might be tempted to avoid using your affected hand, relying instead on your "good" hand. However, this can make the problem worse. Shortening of the muscles can begin within hours of a stroke, rapidly leading to contracture. This can in turn cause adhesions to develop, which leads to a loss of elasticity and range-of-motion in the joint. The problem starts in the brain, so it’s necessary to change the way that the brain communicates with the muscles in order to permanently treat spasticity and prevent contracture.

 If you have spasticity in your hands, then you will likely start with stretching exercises. There are several handy tools that can make these stretches easier and more effective. These tools can provide relief and make exercising the hand possible even if it is clenched or tight.

Tools for Treating Spasticity and Contracture

Hand splinting is an effective way to help stroke survivors minimize joint stiffness and pain while performing stretching exercises. In the past, static splints were the only option for this purpose. Even though static splints are still widely used for spasticity, the research is still out on whether or not they help with spasticity after a stroke. Plus, static hand splinting has been found to cause hypermobility, joint damage and contractures.

 Dynamic splints are now preferred over static hand splinting. These types of splints are better tolerated for extended periods of time compared with static splints. They are effective and do not carry the risks of joint damage and other problems that are associated with static hand splints.

The SaeboStretch is a dynamic hand splint that helps stroke survivors improve function in their hands. This splint allows the fingers to move and flex, enabling people with spasticity to stretch their hands safely and comfortably. The SaeboStretch is ideal for treating varying degrees of spasticity, thanks to its three interchangeable dynamic handpieces, which can be swapped out to suit individual patient needs.

 It is important to remember that hand function can be improved at any stage. Even if the hands and fingers are severely and painfully clenched, it is possible to relax them and restore function. Severely impaired stroke survivors have regained arm function after physical therapy and occupational therapy, and as the technology and treatments improve, so do the results. Here at Saebo, we are committed to stroke support and recovery for all survivors and their families. Saebo offers a wide range of products that combine cutting-edge technology with evidence-based rehabilitation techniques. Our offerings and network of Saebo-trained therapists can help you or a loved one to obtain the necessary tools to maximize your recovery.