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Treatments of Dupuytren’s Contracture to a Soaring High Five!

Slowly but surely- this is how Dupuytren’s contracture progresses. A hand deformity that develops gradually, usually manifesting symptoms at age 40 onwards. Named after Dr. Baron Guillame Dupuytren, this disease is a fixed flexion contracture of the hand; oftentimes, the fingers are bent towards the palm and can’t be extended to its full extent. Years and centuries after the Dr. Dupuytren’s brave attempt to correct this affliction, more treatment of Dupuytren’s contracture have been discovered and implemented.

Treatments of Dupuytren's Contracture to a Soaring High Five!
  • If the disease progression is still at its onset and your hand abilities are still intact, you may not need any treatment yet. But, as this is a slow-pacing thief, you need to do early remedies, applicable at home, or anywhere you may be. Stretching your fingers – bending them backwards from your palm or placing your fingers flat on a table while lifting your palm – can be very helpful to diminish flexion. Before doing this, apply a heat pack on your hand, and massage your palms with a lanolin cream. As much as possible, in any grasping or gripping tasks, protect your hands by wearing heavily-padded gloves or building up handles with cushion tape or pipe insulation. Simply, avoid extreme and prolonged hand flexion!
  • But if the disease is highly unstoppable, at the peak of its symptomatic stage, medical treatment should get involve. This shall include removing or breaking apart the cords that have attached, thus pulling your fingers in toward your palm. Choice of procedure is based on the severity of the disease and other health issues you may have.
  • A treatment that does not require any incision, needling technique uses a needle, inserted through the skin which breaks or puncture the tissue cords that contract the finger. Yet, contractures may recur but the procedure can be done on several fingers at the same time with a very little physical therapy needed afterwards. However, don’t overdo it, as it may damage a nerve or tendon!
  • Enzyme injections apply the same principle to needling. Enzymes are injected to puncture the cord – by making it soft and weak – so that the doctor can manipulate the hand, break the cord and straighten your fingers. No incision needed, but it can be painful initially.
  • For worse cases and long term – if not lifetime results – surgery allows the doctor to remove all the tissues that are affected by the contracture and gaining complete joint release. Just like its prolonged advantage, surgery may require long term recovery and intensive physical therapy.

Hands are man’s productivity tool. Although, the disease can be genetic, acquiring it still depends on how much we take care of our hands or how early we receive treatments of Dupuytren’s contracture, and regain that soaring high five!

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Finger Contracture: Causes, Symptoms and Treatment

Contracture of the hand, wrist and finger is caused by the shortening of connective tissues, muscles and tendons resulting to the inability of the joints to extend. A wrist contracture could be brought about by the formation of scar tissue around or in the joints. This leads to limited extension and restricted movement of a person’s wrist.

Often, finger contractures are precipitated by the disease called Dupuytren’s contractures. This disease is progressive in nature and affects the tissues under palm’s skin which is the palmar fascia. The triangular, strong and thick fascia is located in between the skin and the tendons, with attachments below and above, extending into the fingers. While the palmar fascia shortens and thickens because of the disease, the person’s fingers could gradually be pulled to the palm taking away the capability of the fingers to be straightened. The progression of this disease varies from one person to another. Also, the occurrence of symptoms could not be predicted, although, the contracture is more likely to happen when a member of your family has had this disorder. Other contributing factors would include being male, diagnosed with seizure disorders, if you are alcoholic and have undergone any hand surgery.

The symptoms are most often experienced in both of a person’s hands with the little and ring fingers being affected tremendously. The thumb and the index finger are rarely affected.

Causes of Contractures:

  • Hand Injury or Surgery: These form scar tissues especially during the recovery process. If the scarring happens within a position that affects the normal movement of a person’s finger joints, contractures could result.
  • Family History: The finger contracture causes are unclear. However, there is a 65%-70% chance that this could be brought about by a history of the condition within the family.
  • Other causes: The following factors have not established a strong connection to the finger contracture disorder, although, these increase a person’s risk of having it. These are: liver disease, epilepsy, alcoholism, diabetes, Viking and North European Ancestry, smoking, being male and senior citizen.

Symptoms:

The initial symptoms are tiny nodules within the hand most especially in the palm near the fingers. These might be painful in the beginning; however, pain disappears with time. The person may start to pucker and the palm’s painless cords could extend towards the fingers. In trying to extend the fingers, the skin may blanch and it could lose color. The range of motion could be restricted and the normal ability of the hand to function properly may be reduced.

Treatment:

Finger Contracture: Causes, Symptoms and Treatment

Today, there are already two options for treating finger contractures. The outcome of each of these options will depend mainly on the maturity of the scar tissue. If the finger contracture occurred just recently, the best method to correct the disorder is to wear a splint on your wrist together with a few other hand exercises to improve your range of motion.

On the other hand, when the scar tissues are more than 3 months old, improving your range of motion is impossible already; hence, surgery is your best option. The purpose of surgeries will be to get rid of the scar tissues to be able to loosen up the finger joints, even if it could not be removed entirely and newer scar tissues have piled up on top of the older layers. After the operation, a splint should be worn for at least 6 weeks. The use of the splint should be gradually reduced as hand stretching exercises are introduced.

For Dupuytren’s disorder, the main treatment will be composed of a “wait and see” scheme. This is because before the any medical procedure is done, an observation is recommended to be able to determine the extent of damage. In a few cases, early treatment provides the patients hope that the disease is still manageable.

Aponeurotomy is the procedure most often utilized to separate finger cords; hence, restore mobility. This can be performed under an outpatient registration. This treatment method is preferred by many because this is not as invasive as others and scar tissue formation is lessened. Recuperation care will include using a splint for a specific number of hours each day.

After a surgery, recurrence is still possible, rehabilitation could be lengthy and complications might happen.

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Dupuytren’s Contracture of the Hand: Facts at Hand

Oftentimes, people take our poor hands for granted, not realizing how much and how many ‘they’ can do. Being unable to grasp, grip, or hold something can be a horrible experience. And these are really true for people suffering with Dupuytren’s contracture of the hand.

Dupuytren’s disease or Dupuytren’s contracture of the hand is a fixed flexion of the hand, usually the ring and pinky fingers towards the palm. Why does it happen? Usually an autoimmune disease, immune system cells over actively behaves, attacking own cells leading to scar tissue formation or fibrosis. These scar tissues form a thickened, shortened cord that forces some of the fingers to curl inwards towards the palm, creating the hand deformity.

Dupuytren’s Contracture of the Hand: Facts at Hand

Also called a Viking Disease, legends say that Vikings spread the disease throughout Europe and Scandinavia hundreds years ago. Fact or myth, the disease really has a higher incidence rate in European countries such as Norway, Scotland, Iceland and Australia – where the Viking ancestry is predominant.

But it was until 1600 that the disease had been fully described by Swiss Doctor Felix Platter. Although this was recognized, it was still French Surgeon Baron Guillame Dupuytren who acquired the name of the disease for successfully initiating the operation for the retracted finger in 1831.

Decades have past but still the issue on what exactly causes Dupuytren’s contracture of the hand is still a big question mark. However, it is mostly associated with genes and family history. 60-70% of incidence runs in families. Men after age 40 are closely at risk, more so, those with North European/Viking ancestry. Trauma, diabetes, epilepsy and liver disease are also identified factors but still unexplainable. Meanwhile, smoking and alcoholism are sure precipitating factors as they affect blood circulation and tissue oxygenation – the less oxygen our tissues could get the higher chances of abnormal immune responses!

Most of the time, small, painless nodules in the palm are the first clinical signs. These nodules may begin to merge and become a more obvious lump on the skin. On later stages, the skin and underlying fascia contracts, including some fingers bent inwards, causing impairment of the hand and finger function. All fingers may be involved but most commonly the ring and little fingers are affected. Whilst nodules progression is rapid, the changes resulting to symptoms can be very slow. Thus, most of the time, patients would only seek consultation at its later stage, and shall be diagnosed through the table top test. Inability to place the hands, with the fingers, completely flat at the table renders a positive result.

Dupuytren’s contracture of the hand can be less painful, but it can be a nuisance in hand-involved activities. When this happens, medical treatment is initiated. The needling technique and the enzyme injection procedure both involve puncturing the cord and breaking it apart, to release the flexion. Although, these are non-invasive, recurrence is highly possible. For long term and hopefully lifetime treatment, surgery is advised. However, rehabilitation and physical therapy may also take a longer time.

Dupuytren’s contracture of the hand may be hereditary, but preventing its initiation and progression by protecting it from any kind of trauma, depends entirely at our hands!

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Dupuytren’s Contracture of the Foot Rediscovered and Redefined

Ever heard of Dupuytren’s contracture of the foot? Nah, contracture of the hand is more popular but abnormal foot flexion is seldom discussed. What it is and what actions should we take to treat, or possibly, to prevent it?

Dupuytren’s Contracture of the Foot Rediscovered and Redefined

Dupuytren’s contracture of the foot is known as Ledderhose’s disease (LD), plantar fibromas or Morbus ledderhose. Like the hand disease, it is a type of fibromatosis – scar tissues developing inside, usually under the skin. Causes are still unknown but it is closely related with autoimmune diseases. Our body’s immune system destroys our own cells and forms scar tissues and accumulates excess collagen. What a weird yet hideous way of betrayal inside our body!

As exact causes are still unknown, risk factors are identified for precautions, early detection, and treatment. A person with family history of both Dupuytren’s curvature of the foot and the hand may incur the disease, much worse, when he is a Caucasian male with over 70 years of age. A person with other health problems such as diabetes mellitus, epilepsy, liver disease, and thyroid problems poses higher threat of acquiring it. Smoking and alcohol use can stimulate cell mutation – leading to an abnormal immune response – thus, both lifestyle-related factors have been included. Foot trauma and overuse of the feet may also place you at risk, as well as punctures – wounds or tears can cause fibromas or scar tissues.

What happens with Ledderhose’s disease? Scar tissues, as above, also called plantar fibromatosis grow on the plantar surface or the sole of the foot. These are firm masses that grow slowly along the plantar fascia- which runs from the heel to the toes on the bottom of the foot- containing excess collagen or fibrotic tissue. At earlier stages, fibromas are small and do not impact foot’s ability. As they grow bigger at your sole, flexing your foot or bending the toes becomes more difficult and walking becomes painful. Early symptom includes a painful and noticeable lump in the arch, firm to touch and grows over time. Multiple fibromas may develop or they can merge to form a unified lump! As they grow in size, wearing shoes or walking barefoot might be very painful.

Dupuytren’s contracture of the foot is diagnosed by excising a part of the fibroma. Most of the time, the disease can be confirmed. But to visualize this, imaging studies are done such as MRI. MRI results shall help the doctor to determine shape, size and depth of the fibroma. In most cases, it even reaches the aponeurosis – the flat, fibrous sheet of connective tissue that attaches muscle to the bone. A thorough medical history shall also be taken to identify predisposing and precipitating factors leading to the disease.

Dupuytren’s Contracture of the Foot Rediscovered and Redefined

Once diagnosed, treatment shall proceed based on the size and location of the fibroma and the pain it causes. Small fibromas causing minimal pain shall include treatments aimed to alleviate direct pressure on it. This is done through padding, functional foot orthotics, heel lifts, night splints or arch support. Reduction of pressure does not only minimize pain but shows to shrink the lump. Verapamil gel, a calcium channel blocker, usually used for cardiac problems, is applied to the mass twice daily to ‘constrict’ the fibroma.

For larger fibromas that inflict greater pain, two invasive treatment options are available. Cortisone injections stall the progression of the disease temporarily but may also induce inflammation. Surgery can also be done but with more accuracy and care since nerves, tendons, and muscles are located in the foot.

Now that you have rediscovered and redefined Dupuytren’s curvature of the foot or Ledderhose’s disease, you might think about your chances of acquiring it and ways of preventing it. Remember, prevention by being aware and living a healthier lifestyle is still the best deal than starting a cure!

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9 Common Finger Joint Disorders

Joints are bestowed a tough function in the person’s optimum movement. They should support the weight as well as provide bones the ability to make smooth and painless movements. These functions make them one of the most worked-out parts of the body. Aside from the joints normal wearing and tearing, the joints are often times injured because of infection, overuse, misplaced immune system attach and degeneration. Among the most common joint disorders are:

Dislocation

This is one of the most common finger joint disorders. It is the luxation or dislocation of a finger joint characterized by a displaced articulating bone which most often is a result of bad landing from a fall. Aside from the finger joint, the joints of the jaw, fingers, elbows, knees and shoulders are typical sites for this kind of injury. This bone displacement produces a joint deformity, swelling, localized pain and inability to move affected bones.

Bursitis

Excessive joint use of bursa stress can cause bursitis – this is the inflammation of the bursa. The bursa, which is located in between the calcaneus or the heel bone and the popular Achilles tendon, might become inflamed when put to sudden strenuous physical activities. Aside from this, a kind of bursitis referred to as the “tennis elbow” actually affects the body’s bursa in between the skin and the olecranon process. Rest is the most efficient treatment of choice for bursitis; however, seeking for the advice of a doctor is beneficial.

Sprains

This joint disorder results from tearing or overstretching of the connective tissues, tendons and ligaments. However, this does not misplace articular bones. Forceful twisting or wrenching the ankles and/or ankles results to sprains of the ankles or wrist. For instance, excessively inverting your ankle could result to a sprain because the ligaments located on the lateral surface are being stretched. Serious injuries might pull all of these tissues from where they are loosely attached.

A joint that is sprained is swollen and painful, almost all of the time restricting movements. The first aid for sprain is taking a rest, while the more serious cases need medical attention. Nevertheless, joint immobilization for some specific time-frame could cause ligament weakness and bone resorption. Also, exercises could help in strengthening the joints.

Arthritis

This is disease condition which causes painful, swollen and inflamed joints. There are several kinds of arthritis and have affected more than 50 million citizens of US. Also, arthritis could be a member of some syndromes. The most usual forms of arthritis are:

Lyme Arthritis

Often called the Lyme disease, this is an infection caused by bacteria. The infection is passed through a tick bite which will then cause an intermittent arthritis of the body’s joints. Intermittent arthritis usually happens after the first few symptoms occur like pain, flu-like syndrome, fatigue and rashes.

This disease was first discovered in the town of Lyme, Connecticut where a woman wrote a journal about her younger neighbors’ juvenile and rare rheumatoid arthritis. This woman’s observations became the basis of Allen Steere’s research about this tick-borne infection. When antibiotic treatment is started during the appearance of the first few symptoms, other kinds of arthritis will be prevented.

There are also other kinds of bacteria which causes arthritis. These include the common Streptococcus and Staphylococcus species, Mycobacterium, and Neisseria gonorrhea. Furthermore, arthritis, a few times, is associated with acquired immune deficiency syndrome due to the fact that while the immune system of the affected person breaks down, the risk of developing the infection will increase.

Osteoarthritis

This is a degenerative disorder and is recorded as the most common kind of arthritis. This most often comes with age. However, an arthritis that is inherited may occur earlier in life. The most common initial form of symptom is an unusual joint pain. Slowly, the affected joint will deform. For instance, fingers affected with arthritis appear gnarled or the knees are bulged.

With osteoarthritis, the articular cartilage gradually disintegrates and softens, slowly roughening the surfaces of the affected parts. Joints then are unable to make full range of motion and eventually become very painful. For instance, fingers affected with arthritis might lock in place while playing an instrument or tying his shoelaces. Most often, osteoarthritis affect joints which are utilized the most like those that are found on the knees, hips, fingers and vertebral column.

Luckily, NSAIDs have the power to control the symptoms of osteoarthritis. Exercise could make joints become more flexible. If the daily exercise routine is successful, wearing gloves and tying shoelaces will become easier.

Rheumatoid Arthritis

This is an autoimmune disorder where the person’s immune system attacks healthy tissues. This kind of arthritis is the most debilitating and painful. The body’s synovial membrane located in joints thickens and becomes inflamed, forming a tissue mass referred to as the pannus. The articular cartilages then become damaged giving the fibrous tissue the chance to infiltrate it, hence, interfering with the movements of the joints. Eventually, the joints will ossify and the articulated bones fuse together. Surgery is the treatment of choice for RA especially when the joints are damaged severely.

Gout

This actually is a metabolism error acquired even before birth. This is an inherited illness where the missing or defective enzyme causes the certain bodily chemicals to build up. With gout, the crystals of the uric acid accumulate in the joints, most often in the metatarsophalangeal joint. In the past, gout was thought to have been caused by consuming rich foods. In a certain condition referred to as the pseudogout, a different kind of uric acid crystal accumulates most often in the wrist or knee joint.

9 Common Finger Joint Disorders

Dupytren’s Contracture

This condition attacks the palmar fascia – the tissue that is lying beneath the palm. This is a thickened tissue which lies just above the tendons and under the skin in the hand region. Palmar fascia is actually attached to both the structure below and the skin above. This condition causes tightening or contractures of the hand tissues. Due to the contractures, the person’s fingers could be permanently bent; thus, making the hand’s movements impaired.

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