Over the course of my nursing career I have come in contact with patients that for one reason or another have hand contracture. This is where the muscles/tendons/ligaments shorten making it difficult and painful to fully extend the affected part of the body.
The hand differs from other parts of the body in that it has multiple joints in close proximity (as opposed to a single joint of the elbow or knee) and it also has an added degree of difficulty; fingernails. When the hand becomes contracted, the challenge we often face is a clenched hand can become sweaty. That added moisture combined with finger nails digging into the palm can cause maceration, fungal infection, and potentially fissures.
Our goals in this circumstance are to prevent skin breakdown, improve range of motion, and provide adequate cleansing with activities of daily living. The barriers to achieving this are often the unwillingness of the patient to participate with pain commonly being the limiting factor.
The most immediate thing we can do to prevent further deterioration is to roll up a washcloth and place it in the patient’s palm like they would hold the handle of a baseball bat. This prevents the finger tips from digging into the palm and also slightly extends their fingers. Gradually, we can give the patient larger cylinder-type objects to hold to improve their range of motion and improve the contracture.
If necessary, consult the wound care specialist and/or physical therapy. As always, educate the patient and family on the need to increase/maintain range of motion, keep the hand clean/dry, and trim or file the nails to prevent complications.