Patient presented with a chronic history of bilateral hand weakness & stiffness. His symptoms were always worse in the morning and eased as he used his hands during simple activities throughout the day.
His primary concern is an inability to move his hands and fingers quickly when he wants to.
Neurological examination unremarkable. No radicular signs. Reflexes intact bilaterally. Muscle strength good bilaterally.
Range of motion; unable to make a closed fist. Unable to fully extend the finger with an open hand.
Bilateral wrist range of motion; Flexion = 60 deg. Extension = 30 deg. Radial deviation = 10 deg. Ulnar deviation = 20 deg.
Perfusion; unremarkable bilaterally.
Palpation; severe joint restriction of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints.
Palpation; hypertonicity in the forearm flexor and extensor muscles bilaterally.
Vascular Testing; Hautant’s/Maigne’s (Seated) & VBI (Supine); No abnormalities detected.
Education & Advice.
Active releases of the forearm muscles
Bilateral traction and circumduction mobilisation of wrist.
Traction mobiliations of the MCPs, PIPs, and DIPs.
Kinesiology taping techniques
Self traction exercises of the wrists and fingers.
Self massage and acupressue therapy of the forearm flexor and extensor muscles.
Stretches of the forearm flexor and extensor muscles.
After 5 consultations over a 6 week period the patient reports; improved grip strength and greater mobility and functionality.