Maintaining balance in the hand is one of the most challenging things to do as a therapist. One must consider both the intrinsics and extrinsic muscles that affect the hand, ligamentous structure, load or repetitive load applied to the hand and upper extremity to state the least. It is important to look at the architecture of the hand, the bones:
Image from: Anatomy of the hand. Teton Hand Surgery. (2023, July 10). https://tetonhandsurgery.com/service/anatomy-of-the-hand/
Are we dealing with a broken bone, and arthritic joint, ligamentous laxity? These are all structural problems that need to be addressed first before we can look at any other structure. Bracing/splinting is extremely effective in helping architectural issues in the hand.
Once the architecture of the hand is understood or stable, it is important to understand what the intrinsics and extrinsics muscles are doing to the hand. Is this an overuse injury? Are the flexors and extensors of the hand at full length? Is the superficial and deep line anterior and posterior line of the arm in balance? All of these questions need to be addressed to properly treat muscular issues in the hand or forearm.
