Fingers bend forwards, onto the palms. It can be just the ring, or the little finger. Yet worst, it can be both or more!
Dupuytren’s disease is a deformity of the hands, characterized by the fingers flexed towards the palm and the inability to straighten it. But this disease is just one of the many contracture disorders. As the fingers are composed with small joints with a complex arrangement of bones, ligaments, tissues and tendons that enable movement and stability, any type of fractures, injuries and even a small amount of swelling and scar formation, just like in Dupuytren’s disease or any disruption on this arrangement, can block a joint motion leading to contracture.
How does a contracture resolved? Or simply, how is a finger contracture release done? Since a contracture can be caused by a variety of reasons, then the treatment shall be cause specific too! For patient with Dupuytren’s disease, finger contracture release is not the first step. A doctor must first confirm the diagnosis through a table top test. A person who is unable to place his hand completely flat on the table is positive. Further imaging studies are then conducted and a detailed medical history is taken to assess the severity of the condition.
Oftentimes, conservative treatment is the first choice, which includes progressive splinting to stretch the blocking cord, steroid injection and enzyme injection, both to puncture the cord. Yes, these procedures are less invasive, but recurrence is highly possible and aggravating. Thus, when table top test is positive and the hand ability is greatly affected such as trouble in grasping or putting objects in the pocket, finger contracture release through surgery is then advised.
In Dupuytren’s disease, the palmar fascia tightens, causing the fingers to bend inwards. Why does it tighten in the first place? Research says it is autoimmunity – body cells attacking our own cells, and scar tissue forms, creating a cord into the fascia. This cord or nodule gets larger, and its hold to the fascia gets tighter. Once the grip becomes so unbearable, intolerable, and life-impacting, finger contracture release should be done. Thus, the aim of the surgery is to remove the unhealthy fascia, untie the grip, unfasten the hold, and ultimately allowing the fingers to straighten out again. In some cases, skin grafting in the area close to the incision gives the finger more freedom and flexibility to extend or straighten.
During the actual surgery, an incision shall be created on the skin. Once the affected palmar fascia is seen, it is then carefully separated from the nerves, arteries, and tendons. Extra precautions are taken with utmost care so that the nearby nerves and blood vessels will not be damaged. Gently yet surely, the surgeon shall then remove enough of the palmar fascia to straighten the finger/s. Once the diseased tissues are removed, the skin is sewn together with fine stitches.
After surgery, your hand shall be bandaged with a sufficiently-padded dressing and a cushioned splint. This shall keep the hand in neutral position, and the fingers straight, ready for healing. Five to seven days after, your surgeon shall re-examine your hand and after 2 weeks, some stitches shall be removed. Since lots of nerves are found in the hand, discomforts may appear after surgery. Pain medications are given to control or relieve the temporary pain. Post-op patients are also advised to keep their operated hand elevated to avoid further throbbing and swelling, with a stack of pillows when sleeping of sitting up.
Although rare, complications might occur after surgery such as nerve and blood vessel injury, and infection. Thus, following-up with the doctor is very important to ensure that you are healing well and finger contracture release has been done gently, surely and successfully.