Spasticity after stroke is a condition that causes stiff, tight muscles. When it affects the hand in a significant way, it can lead to a clenched hand or curled fingers after stroke. Severe spasticity in the hand is ultimately caused by disconnection and miscommunication between the brain and muscles that control the hand.

Fortunately, there are ways to rewire the brain and restore mobility in the hand and fingers. This article will discuss the causes and treatment for severe hand spasticity and curled fingers after stroke.

What Causes a Clenched Hand & Curled Fingers 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, such as a stroke in the motor cortex, it disrupts that communication between the hand and nervous system. As a result, the hand muscles tighten up for protection, which can lead to hand spasticity and curled fingers after stroke.

Spasticity is a condition that refers to stiff, tight muscles. When left untreated and unmanaged, spasticity 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 and, in the case of hand spasticity, causes fingers to curl into the palm.

It’s important to manage spasticity early to prevent contractures from developing. However, once spasticity has progressed to contractures, there are still ways to relax the muscles in the hand and fingers — it will just take more time.

Before exploring the different methods for hand spasticity treatment, we’d like to stress the importance of stretching your hand daily in order to avoid learned non-use and to prevent hand spasticity from worsening.

How to Prevent Spasticity in the Hand from Worsening

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.

This is where the popular neurorehab phrase “use it or lose it” comes from. If you don’t use your hand by at least stretching it intentionally on a daily basis, then you will continue to lose hand function and the fingers will continue to curl tighter into the palm.

Fortunately, there’s another popular phrase among neurorehab therapists: “use it to improve it!” The hand spasticity treatment options below will help you put this into practice.

How to Treat a Clenched Hand After Stroke

There are many hand spasticity treatment methods available to help relax a clenched hand and curled fingers after stroke. It often works best to use a progressive approach, which means starting with a basic, simple technique and moving onto more complex methods as you improve.

Be sure to work alongside a therapist as clenched hands are a sign of severe spasticity, and help from an expert is often crucial for recovery.

Here are the methods your therapist may recommend to treat hand spasticity after stroke and help relax curled fingers:

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 muscles and connective tissue helps prevent spasticity from worsening into contractures. If contractures are already present, causing fingers to curl into the palm, then stretching will help prevent spasticity from worsening — as long as you perform the stretch in a pain-free range.

Furthermore, stretching the affected hand and focusing your attention into your hand as you stretch will help stimulate the brain and encourage it to rewire itself. Sensory stimulation (looking at your hand while you feel the stretch) helps combat learned non-use and helps to begin relaxing the fingers.

2. Hand Spasticity 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 survivors consider exercise when they have severe spasticity in the hand after stroke. However, exercise is arguably the most effective activity for hand spasticity.

Practicing therapeutic hand movements on a consistent basis helps spark neuroplasticity: the process the brain uses to rewire itself. As hand spasticity exercises are practiced with high repetition, the brain works to both create and strengthen neural pathways that communicate with the affected hand muscles.

As the brain starts to regain the ability to send signals to the affected hand, it also regains the ability to send signals that tell the hand and fingers to relax. Ask your therapist to recommend hand spasticity exercises that are most suitable for you.

Also, keep in mind that exercise is not an immediate choice for all survivors with a clenched hand or curled fingers after stroke. Instead, passive exercise can be pursued, which we’ll discuss next.

3. Passive Exercise

Quick tip: Passive exercise is an accessible form of hand spasticity exercise for most stroke survivors with clenched hands. Best of all, it helps spark neuroplasticity and promotes recovery.

When severe hand spasticity and 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 affected hand, studies have shown that the passive movement helps spark neuroplasticity. This provides hope for stroke survivors with hand contractures, because 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 hand exercise is the best place to start relaxing spasticity in the hand after stroke.

4. Botox

Quick tip: Botox is a “nerve block” that temporarily relieves hand spasticity and helps relax curled fingers 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 and loosen the fingers.

Botox wears off after several months, which requires repeat injections. For a long-lasting solution, rely on daily hand spasticity 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. Electrical Stimulation

Quick tip: Electrical stimulation helps stimulate muscle movement and can encourage curled fingers to extend into a more open position.

If your therapist deems it appropriate, electrical stimulation can be a great way to treat spasticity in the hand after stroke. During this therapy, electrical stimulation is applied to specific muscles to cause them to contract. When electrical stimulation is applied to the forearms, for example, it helps extend the fingers so that they open away from the palm.

In the video below, you can watch a therapist demonstrate electrical stimulation for finger extension. He places the pads on muscles in the arm to help extend the fingers. This is a great example of why you want and need a therapist’s help to use electrical stimulation, because they know where to place the pads and how to safely apply the stimulation.

Electrical stimulation works best when combined with hand therapy exercises to provide as much stimulation to the brain as possible. While it helps to use e-stim to cause your fingers to extend, and it’s even better to intentionally try to extend your fingers through exercise. Intentional movement is key for activating neuroplasticity and improving spasticity in the hand after stroke.

6. Hand Therapy Exercise Devices

Quick tip: With consistency and repetition being the keys to recovery from hand spasticity, survivors can look to interactive devices for motivation.

Your therapist will send you home with hand exercises to do on your own between therapy sessions to keep neuroplasticity engaged. Studies have shown that paper sheets of exercises have poor compliance rates, though, which suggests that motivation and accountability are helpful for recovery.

This is where interactive hand therapy devices can help. For example, Flint Rehab’s MusicGlove is a sensorized glove that tracks your movement as you exercise your hand in sync with a musical game. It’s fun and motivating to use, and it’s both FDA-approved and clinically proven to improve hand function within 2 weeks of use. Survivors with clenched hands may need to use the device passively to accomplish the exercises, which sparks neuroplasticity all the same.

Bob & Brad, two physical therapists on YouTube with over 4.5 million subscribers (at time of writing), gave MusicGlove the thumbs up. They were not paid to review MusicGlove and they are not affiliated with Flint Rehab in any way.

7. Baclofen

Quick tip: While this medication does not stimulate changes in the brain, it can provide short-term relief from spasticity.

Baclofen is a medication that helps relieve spasticity by inhibiting the release of body chemicals that cause muscle contractions. It can be taken orally or, when spasticity is severe, it can be administered directly to the spinal cord via an intrathecal baclofen pump.

If spasticity is not only affecting your hand but severely affecting your quality of life, you can talk to your doctor about this invasive option. It requires surgery and should be considered only once all other options have been exhausted.

8. 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.

A clenched hand after stroke is often a result of a severe stroke, which has caused severe spasticity. It’s likely that survivors need 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 and allows the fingers to slowly relax and loosen. Movement is key to recovery.

How to Treat Spasticity in the Hand After Stroke

Overall, spasticity in the hand after stroke can lead to a clenched hand and curled fingers when the condition is left unmanaged. The best hand spasticity treatment is exercise, because it helps rewire the brain and restore the brain’s ability to send the right signals to the hand.

Passive exercise (where the hand is passively moved through each exercise) is a great place to start as it activates neuroplasticity and is accessible to most survivors with curled fingers after stroke. Talk to your physical or occupational therapist to see which combination of hand spasticity treatments are most suitable for you.

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