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  • Writer's pictureRobin R Varghese, PT.

Is Dupuytren's contracture bothering you? It doesn't matter, we are there to help you!!!


Dupuytren’s contracture is a condition in which one or more fingers become permanently bent in a flexed position.

  • It is a benign, myeloproliferative progressive disease of the palmar fascia which results in shortening, thickening, and fibrosis of the fascia and aponeurosis of the palm.

  • The ring finger followed by the little and middle fingers are most commonly affected. It can interfere with preparing food, writing, and other activities.

  • The cause is unknown. It is a genetic disorder with a multifactorial etiology. It is associated with diabetes, seizure disorders, smoking, alcoholism, HIV, and vascular disease.

  • Risk factors include family history, alcoholism, smoking, thyroid problems, liver disease, diabetes, previous hand trauma, and epilepsy.


The underlying mechanism involves the formation of abnormal connective tissue within the palmar fascia.

There is abnormal myofibroblastic growth in the hand.


The three phases are:

(1) Proliferative ( with characteristically high concentration of immature myofibroblasts and fibroblasts arranged in a whorled pattern) ,

(2) Involution (fibroblasts become aligned in the longitudinal axis of the hand following lines of tension) , and

(3) Residual (relatively acellular collagen-rich chords remain causing contracture deformity).


Usually starts with a thickening or nodule in the palm, which initially can be with or without pain. Later in the disease process, several cords can develop which can cause unique deformities of the hand.

  • Pre tendinous cords- skin pitting and metacarpal phalangeal (MCP) joint contracture.

  • Natatory cords- webspace contractures.

  • Spiral cords (the most important in the disease process)-proximal interphalangeal (PIP) contracture.

Symptoms

  • There is increasing loss of range of motion of the affected fingers.

  • The earliest sign of a contracture is a triangular “puckering” of the skin of the palm as it passes over the flexor tendon just before the flexor crease of the finger, at the metacarpophalangeal (MCP) joint.

  • Rarely, tenosynovitis can occur and produce pain.

  • The disease begins in the palm and moves towards the fingers, with the metacarpophalangeal (MCP) joints affected before the proximal interphalangeal (PIP) joints.

  • The palmar fascia within the hand becomes abnormally thick, which can cause the fingers to curl and can impair finger function.

  • weakened gripping.

  • People may report pain, aching and itching with the contractures.

  • The disorder is not always progressive. In at least 50-70% of patients, it may stabilize or even regress.

Types


Type 1: A very aggressive form of the disease. This type is sometimes known as Dupuytren’s diathesis.

Type 2: The more normal type of Dupuytren’s disease and is made more severe by other factors such as diabetes or heavy manual labor.

Type 3: A mild form of Dupuytren’s disease.

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Treatment


Non-surgical treatment includes Steroid injection, enzyme injection, collagenase injections splinting and Physical therapy

Surgical treatment will be required if the contractures interfere with hand functions. Tough surgery will not cure the condition, it can reduce the contractures and improve the mobility of fingers and thus, the functioning of hand.

Physical Therapy treatment



Conservative PT care includes:

  • Ultrasound therapy can soften the soften and maybe reduce the pain.

  • Wax bath prior to exercises can relax the contracted tissue and relieve pain.

  • Splinting especially night splints to slow down contracture.

  • Gentle stretching exercises to release the contracted tissue.

  • Exercises to improve the mobility of the tendons:

  • Tendon glide exercises

  • Exercises to improve strength of fingers

  • Gripping exercises


Post surgical PT care includes:

  • Maintain the range of motion of the hand and fingers is important (for many activities of daily living)

  • Extension splints often are used in conjunction with other modalities.

  • Oedema and scar intervention

  • Post PT care should be undertaken for at least 3 months to prevent contractures.

  • Treatment will be offered to symptomatic patient and we would like you to know that there are many complications to many treatments for this condition.

  • Your Physical therapist will walk you through the protocol that is best suited to your symptoms and get you back to maximum and optimal function.


At Valley Healing Hands, Brownsville, Texas we provide the best physical therapy and occupational therapy for Dupuytren's contracture. We have well qualified and ever willing Physical Therapists and Occupational Therapists who will take care of you and provide you with utmost care and support. Our patients are completely satisfied and you may learn about us here. You may also get connected to us here. Our patients love us, and you too will!!!


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