Scar tissue is a natural biological material the body produces to patch a wound following injury or surgery. This fibrous tissue, made primarily of collagen, forms a structural repair different from the original, supple skin. In the hand, this tissue can quickly limit the precise movements required for daily function. Managing this tissue is crucial for restoring mobility and sensation, involving a combination of at-home and professional methods aimed at softening and reducing restriction.
Understanding Hand Scarring
Scar tissue is composed of a dense, disorganized mesh of collagen fibers, replacing the organized pattern found in healthy skin. This repair can extend beyond the skin, adhering to deeper structures like tendons, nerves, and joint capsules. Because the hand relies on complex, coordinated gliding movements, adherence or restriction can severely compromise dexterity and range of motion.
Scars progress through a healing timeline that can last from several months up to a year or more. Initially, the tissue is considered immature, often appearing red, raised, and firm due to increased blood flow and active collagen production. Immature scars respond most readily to interventions aimed at encouraging the collagen fibers to align in a more flexible pattern. Over time, the scar matures, becoming flatter, softer, and paler.
Manual Techniques for Scar Remodeling
Scar massage is a fundamental technique used to influence the way collagen fibers organize during the healing process. This manual manipulation helps prevent the scar from tethering to the underlying tendons and nerves, which is a common cause of limited hand function. You should begin massage only after the incision is fully closed and cleared by a healthcare provider, typically about two to three weeks after surgery or injury.
The goal is not to painfully “break up” the tissue, but rather to gently remodel the collagen and increase tissue mobility. Apply firm pressure that is sufficient to cause the scar tissue to blanch or turn white, and then move the tissue beneath your fingers. Use a moisturizing agent like a non-perfumed lotion or silicone gel to reduce friction during the massage.
Perform short, focused sessions two to three times a day, working on the entire length of the scar for about five minutes each time. Cross-friction massage is effective, involving rubbing your finger perpendicular to the direction of the scar line. Also use small circular motions directly on the scar, and gently stretch the tissue in all directions to ensure the skin moves freely over the deeper layers.
Dynamic Movement and External Aids
Active and passive range of motion exercises are an accompaniment to manual massage, preventing the scar tissue from becoming restrictive. Movement is a powerful way to retrain the hand and ensure that the newly formed collagen remains pliable, particularly over mobile joints. Specific exercises, such as tendon gliding, involve a sequence of finger and wrist positions designed to maximize the movement of the flexor and extensor tendons beneath the scar.
External aids provide consistent, prolonged pressure and hydration to help flatten and soften the raised tissue. Silicone gel sheets are widely recommended because they create a moist healing environment, which is thought to reduce blood flow and collagen buildup within the scar. The sheets are typically worn for several hours a day or overnight for at least two to three months for the best effect.
Compression can also be achieved through specialized pressure garments or wraps, which physically apply constant force to the scar. This steady pressure works to limit the blood supply to the area, which in turn reduces the excessive production of collagen fibers. By combining movement with external pressure, the scar is encouraged to flatten, thin, and blend more effectively with the surrounding skin.
Professional and Medical Interventions
When home care is insufficient or the scar is particularly thick and restrictive, professional intervention from a physical or occupational therapist is often necessary. Certified Hand Therapists have specialized training in techniques to maximize hand function and are equipped to address complex scar issues. They may employ specialized tools for instrument-assisted soft tissue mobilization (IASTM) to precisely target and release deep fascial adhesions.
Therapists may also use therapeutic ultrasound, which transmits sound waves into the tissue to generate gentle heat and promote circulation and collagen remodeling. For scars that are excessively raised or thickened (hypertrophic or keloid scars), a medical provider may recommend corticosteroid injections. These injections deliver an anti-inflammatory medication directly into the scar to help flatten and soften the tissue.
Surgical revision is considered the final option for severe scarring that causes functional impairment or contracture, where the scar tissue has tightened and pulled a joint into a fixed position.