Upper Extremity Exercise: Tips to Improve Hand Flexibility

These instructions for Children's Hospital of Philadelphia (CHOP) patients describe exercises and tips improve hand fisting or tight finger flexor muscles.

Important information:

Patient instructions:

Activities

If your child's hand is always fisted and they cannot move their fingers out of their palm:

• Try bending the wrist to move the palm closer to the palm side of the wrist and forearm. This might help the hand to open.

• Keep the hand clean and dry.

• Keep fingernails well-trimmed.

• Place a roll of gauze inside the fist to help keep the hand more open until your occupational therapist makes your child a splint.

• Touch the inside of the child's hand often and try to help your child feel objects and shapes with the fingertips and palm side of the hand.

• Your healthcare team might use splints, medicines, and casts to help stretch the hand. Sometimes surgery can help.

If your child can move their fingers away from the palm, your occupational therapist can help you choose activities for your child. Here are a few ideas. Encourage your child to open their hand often.

• Watch your child during play. When you see their hand opening, take note of what your child is doing. Encourage those activities every day. Sometimes a hand will open more when a child is having fun and not thinking about opening their hand.

• Try bending the wrist to move the palm closer to the palm side of the wrist and forearm. Hold the wrist in this position while trying to get your child to open their hands. If your child can move their fingers away from the palm while you bend the wrist, do this throughout the day as much as you can.

• Move the thumb away from the palm and try to get your child to open their hand. If this helps, tell your occupational therapist.

• Play with 2-handed balls line a kickball, beach ball or volleyball. Use a ball large enough to encourage both hands to work. Try to touch the palms to the ball.

• Bat a tennis ball, racket ball, or similar sized ball between the hands on a tabletop.

• Place an interesting object or toy at the center of the body and encourage your child to use the palm side of the hand with the object. You can use simple objects such as a marker, a stick, a ring toy, or other objects which can be easily grasped with one hand.

• Encourage the child to give high fives, wave, and make a stop sign with their hand.

• Play with balls that encourage the hand to open as wide as it can. For some children this will be a small rubber ball or ping-pong ball. Others will need a racket ball, tennis ball, or even a baseball, softball or football.

• Turn book pages.

Splinting

Wearing a splint can help many children by supporting the hand's natural curves and structure, and by stretching tight muscles and tendons. Splints can be helpful even when your child's hands are not fisting, like when they are relaxed at night. Your occupational therapist will tell you if a splint is right for your child. If your child is prescribed a splint, they should wear the splint as directed. If they have trouble, contact your occupational therapist.

Stretches

Your occupational therapist will show you stretches to help your child. One example is to stretch the fingers out and the thumb out and away from the palm of the hand with the wrist back like a "high five" position or a stop sign position. If your child's hand is too tight for this stretch, try bending the wrist down towards their feet.

Reviewed on December 1, 2022, by Meghan Burkhardt, MS, OTR/L, BCP