After a severe stroke, it’s common for the hand to clench into a fist, and the fingers to curl into themselves. This is a result of severe spasticity, which is caused by disconnection and miscommunication between the brain and muscles.
If you suffer from curled fingers or a clenched hand after stroke, it’s important to understand how the brain and muscles normally communicate. By understanding that connection, the path to recovery becomes clear.
Cause of Clenched Hands After Stroke
Normally, the brain and nervous system are in constant communication with your muscles. The brain is responsible for telling your muscles when to move, and when to relax.
When a stroke damages the part of the brain that controls hand function, it severs that communication between the hand and nervous system. As a result, the hand muscles tighten up for protection, which leads to a clenched hand.
Stiff, tight muscles after stroke are a sign of spasticity. When spasticity is left untreated and unmanaged, it can worsen into a condition called contractures. This is characterized by extreme stiffness in the muscles, joints, or connective tissue that limits range of motion.
It’s important for stroke patients to manage spasticity early to prevent contractures from developing. However, once spasticity has progressed to contractures, there are still ways to relax the muscles. However, it will take more time.
You’re about to learn different methods to treat a clenched hand after stroke. Before we get there, we’d like to stress the importance of stretching your hand daily. If you neglect the affected hand, it will continue to clench into a tighter fist.
Learned non-use is a phenomenon that occurs when a person neglects their limb and the brain completely disengages from it. This is one way that the brain tries to be efficient, but it can make recovery more difficult for the patient.
This is supports the phrase “use it or lose it”. Be sure to keep the hand engaged in daily activities, even if it’s just for a short amount of time.
Progressive Treatment for Clenched Hands After Stroke
Up next, you’ll discover various rehabilitation techniques to relax a clenched hand after stroke.
It often works best to use a progressive approach, so the following techniques are listed from basic to complex. Be sure to work alongside an occupational therapist, as clenched hands are a sign of severe spasticity, and help from an expert is often necessary and crucial for recovery.
Here are the methods commonly used to treat a clenched hand after stroke:
1. Hand Splints
Quick tip: Hand splints are a great starting point because they help prevent contractures from worsening. This is not a total solution, but it’s an essential first step.
As we previously stated, daily stretching is important for patients with clenched hands and curled fingers after stroke. Ask your therapist to recommend a good hand splint to help keep your hand stretched, or see our recommended gloves for stroke patients.
Stretching the hand provides two main benefits. First, stretching the muscles and connective tissue helps prevent spasticity from worsening into contractures. If contractures are already present, stretching helps prevent things from getting worse — as long as you perform the stretch in a pain-free range.
Second, stretching the affected hand helps stimulate the brain. The attention given to the hand helps stimulate the brain and encourage it to rewire itself. Sensory stimulation helps combat learned non-use and helps to begin relaxing the fingers.
2. Hand Therapy Exercises
Quick tip: The best way to relax clenched hands and curled fingers after stroke is to rewire the brain through exercise. However, not all patients can start here.
Not many stroke patients with a clenched hand consider exercise for recovery. However, exercise is arguably the most effective activity for hand contractures after stroke.
Exercise helps spark neuroplasticity, the process the brain uses to rewire itself. Neuroplasticity is at the heart of almost all stroke recovery methods.
When an individual practices hand therapy exercises on a daily basis, the repetition helps stimulate the brain and spark the rewiring process. If the exercise is done consistently, the brain starts to regain the ability to send signals to the affected hand — including the signals that tell it to relax.
However, exercise is not an immediate choice for all patients with a clenched hand after stroke. Instead, passive exercise should be pursued, which we’ll discuss next.
3. Passive Exercise
Quick tip: Passive exercise is an accessible form of exercise for most stroke patients with clenched hands. Best of all, it helps spark neuroplasticity and promotes recovery.
When hand contractures lead to stiff hands and curled fingers, patients may need to start with passive exercise first.
Passive exercise involves assisting your affected hand through a movement. You can ask a caregiver or therapist to help you, or you can even use your non-affected side for help.
Although you’re not exerting effort with your clenched hand, studies have shown that the passive movement helps spark neuroplasticity. This is excellent news for stroke patients with hand contractures. It means that, even though the brain has lost connection with the affected hand, passive movement can help rekindle that connection.
It takes time and consistent effort to see results, but recovery is possible. Passive exercise of hand exercises is the best place to start relaxing a clenched hand after stroke.
Quick tip: Botox is a “nerve block” that temporarily relieves spasticity and helps relax clenched hands after stroke.
Even with passive exercise, some patients may have severe contractures that do not allow the hand to open at all. When spasticity is severe, talk to your therapist about getting Botox injections, which helps relax the muscles.
Botox wears off after several months, which requires repeat injections. For a long-lasting solution, rely on daily hand therapy exercises and prolonged stretching, sometimes with the assistance of a splint, to help rewire the brain.
Many stroke patients see the best results when they use Botox to create the opportunity to wear a splint comfortably, which provides prolonged stretch to the tightened muscles and provides potential for hand function in the future.
5. Progressive, Combination Therapy
Quick tip: Every stroke is different, and every patient will benefit from different approaches. Experiment until you find what works for you.
Clenched hands after stroke are often a result of a severe stroke, which has caused severe spasticity. It’s likely that individuals will need to use multiple techniques to help relax and open the hand.
Talk with your therapist to explore your best options. Some patients will benefit from hand splints while others may want to try Botox. Often both treatments are implemented at the same time.
No matter which path you choose, be sure to make hand therapy exercise the foundation of your regimen. Exercise helps activate neuroplasticity, which rewires the brain.
Movement is key to recovery.
Relaxing Clenched Hands After Stroke
Overall, clenched hands occur after stroke when spasticity in the hand begins to develop. This happens most often after a massive stroke or if the affected hand is neglected for too long.
The best rehabilitation technique includes hand therapy exercises, because this helps rewire the brain and restore the brain’s ability to send signals to relax the hand. Passive exercise (where the hand is passively moved through each exercise) still makes the connection and pathway to the brain.
Talk to your physical or occupational therapist to see what’s best for you. Best of luck on the road to recovery.