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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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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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Fibromatosis Hand

Unusual hand curvatures and abnormal hand flexion, these can all be caused by fibromatosis. A broad medical term, fibromatosis includes a group of ‘mutated’ cells, producing a scar tissue with a distinct biologic behavior. Oftentimes, this is related to an auto-immune disorder, where the body’s own immune system destroys or damages own cells. Although considered benign or localized, the scar tissues have infiltrative growth, thus forming tumor-like lesions and have a tendency towards recurrence. What happens with fibromatosis at your hands?

Fibromatosis hand or palmar fibromatosis is medically called Dupuytren’s disease or contracture. Commonly affecting the hands of adults aged 50 and above, thick cord-like structures or lesions form at the palm of the hand causing the fingers to bend down slowly towards the palm. Definitive diagnosis for this is the table top test. With this, the patient places his hand flat on the table. If the hand cannot lie completely flat on the table with a space from the hand to table is as big as the diameter of a ballpoint pen, then the test is positive and treatment may be required.

Fibromatosis Hand

However, treatment of the disease can be delayed as symptoms occur very slowly and possible causes are not yet identified. Risk factors such as age, family history, a North European race, diabetes, smoking and alcohol use may increase chances of having it. Once positive, treatments are then based on its severity. Mild cases – those that do not impact one’s hand abilities – can do home remedies which are aimed towards avoiding or minimizing hand flexion. Meanwhile, severe cases are encouraged whether to undergo enzyme injection, needling, or surgical procedures to remove or puncture the cord-like formation.

Fibromatosis Hand

Dupuytren’s disease is fibromatosis at your hands! One’s genes might make you at risk of having it, but ‘loving’ your hands and ‘using’ it wisely, plus a healthy lifestyle, hold the definite key to avoid the disease, and even other fibromatosis!

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Finger Contracture Treatment Methods

Dupuytren’s contracture is a disorder characterized by a hand deformity which most often develops gradually over many years. This disorder affects a specific tissue layer which lies underneath your palm’s skin. This affected tissue layer will form knots underneath. Eventually, the knots will form a very thick cord which could pull a finger or more into a curved position.

If this happens, the affected fingers could not be completely straightened. When there are limitations in motion, everyday activities will be affected like shaking hands, putting gloves on and putting hands inside the pocket.

Dupuytren’s contracture usually hits the pinky and the ring finger. Often, they occur in old men that are members of the Northern European descent. There is available finger contracture treatment that slows down the disease progression as well as relieves all of the symptoms.

Drugs and Treatments

If the disorder’s progress is slow, then it has no significant impact on your capacity to make use of your hands and causes minimal or no pain at all, you might not need a treatment. Rather, you can opt to see and wait if the disorder progresses into a more serious case.

The treatment of choice involves breaking apart or removing all of the finger cords which are pulling the fingers toward the palm. This could be achieved in many varied ways. The choice of which medical procedure to go for will be determined through the severity of symptoms and all other medical issues you might have.

Enzyme injections: Injecting a certain kind of enzyme into your taut cord within the palm could weaken and soften it. This will give your doctor the ability to manipulate your fingers, wrist and hand in breaking the cord to straighten out your fingers. The disadvantages and advantages of enzyme injection are the same to needling, except for the fact that enzyme injection is more painful than the other.

Finger Contracture Treatment Methods

Needling: This particular technique will make use of a needle which is inserted straight into your skin to break and puncture the tissue which is causing the deformities of the fingers. Contractures can recur after this. However, the procedure could be repeated until the desired results are achieved. The primary benefits of this technique are that no incision are done, could be done on multiple fingers all at the same time with little or no therapy needed afterward. The primary disadvantage, however, is it could not be utilized in a few locations within the finger due to the fact that it could cause damage to the tendon or nerve.

Home Remedies and Lifestyle

Always exercise your fingers through moving it often. Gently bend the fingers backward. One effective method of doing this is to put your fingers on top of the table with your palms down. When you are already on this position, lift your palm upward on a slow motion while keeping the fingers flat on top of the table.

Use heat and massage. Before doing the stretch, you should warm the hands first using a heat pack while massaging your palm with the lanolin cream.

Protect your fingers. Avoid gripping on tools through building handles up with cushion tape or pipe insulation. Utilize a glove that has a heavy pad if there really is a need to hold on to something.

Treatments

Actually, there is no efficient way to cure or stop Dupuytren’s contracture. Nevertheless, the disorder is not harmful and life-threatening. This disorder often progresses slowly and might not even become troublesome up until its severe case. It might never even progress at all. However, if this progresses, nonsurgical methods might help in slowing down the disease.

Nonsurgical: Splinting will prevent the fingers from bending further. Also, forceful stretching of affected fingers will help and might even slow down the contracture’s progression.

Surgical: Surgeries are suggested when the physician has diagnosed through his measurements that Dupuytren disorder is progressing. A few patients resort to surgical treatments especially when the hand functions are limited already and they are now having trouble holding on to things.

The surgery for this disorder removes or divides the thick bands in order to restore the motion of the fingers. A few times, the wound is allowed to gradually heal by leaving it open. Furthermore, skin grafting might be required. After the surgery, you must elevate your hand above the level of your heart. Gently move your fingers in this position to relieve stiffness, swelling and pain.

Physical therapy might be helpful after surgery and during recovery. Some special exercises could help in strengthening your hands as well as helping the fingers to move.

Complications

Even if complications rarely happen, complications often appear after surgery. During surgery, there is a big risk of injuring the blood vessels and nerves as well as acquiring infection. Although severe complications are rare, some soreness and swelling may occur after the surgery.

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In Focus: Palmar Fibromatosis

Our hands are man’s productivity tool. Being aware of what may inflict them is a key to protect them, just like how palmar fibromatosis affected the hands of powerful history makers, Napoleon Bonaparte and Ronald Reagan.

Palmar fibromatosis, morbus Dupuytren or simply known as Dupuytren’s disease is a hand contracture characterized by the thickening and tightening of the fibrous tissue on the palm of the hand, called the palmar fascia. This causes the bending of the fourth and oftentimes, the fifth finger, towards the direction of the palm.

The challenge with this disease is not just spelling out Dupuytren’s or palmar fibromatosis. The real issue is all about knowing what really causes its occurrence. Named after Baron Guillaume Dupuytren, the surgeon who first described the operation to correct it in 1831, the disease is still an open maze for medical scientists. Although the cause is unknown, the disease tends to run in families. This genetic predisposition is further amplified for those of Northern European descent. Legendarily believed as a disease initially inflicted by the Vikings who have conquered Europe, palmar fibromatosis is also called the Viking’s Disease. In the battle of men versus women, the disease tends to go with men’s strong claw-like hands, and usually starts at age 40 then progresses slowly. The incidence is also greater for people who have existing diseases such as diabetes mellitus, epilepsy, pulmonary disease and liver problems. Plus, alcohol drinking and smoking can augment chances of having it, too, as they increase chances of cell mutation due to lack of oxygenation.

How does palmar fibromatosis happen? Under normal conditions, strips of fibrous tissues, usually soft and pliable, lie under the skin of the palm. This is called the palmar fascia. But in people with Dupuytren’s disease, certain cellular changes occur. Thus, most researchers relate the disease to autoimmunity – our body cell becomes overactive that they attack our very own cells. This process enables scar tissue formation. These scar tissues that develop on the palmar fascia create cords or nodules which tighten and contract the connective tissue. As the palmar fascia tightens, our fingers are bent towards the palm, and cannot be straightened. The process usually starts at the crease on the palm of the hand, and progresses at the joint near the base of the finger, then to the next joint of the same finger. The ring finger is usually the first victim, followed by the little finger. The condition may appear suddenly, yet it progresses slowly that the symptoms are quite unnoticeable, until it becomes severe and life-changing.

How is palmar fibromatosis diagnosed? Simple and easy, the table top test provides the answer. How is it done? A person is instructed to place his hand completely flat on the table. Inability to do so, or existence of even a space as big as a diameter of a ball pen, shall confirm the test, as positive. To determine the gravity of the condition and the location of the nodules, the doctor shall advise the patient to undergo a series of imaging studies and a comprehensive medical history. When a contracture is mild and a person is able to do normal activities, treatment shall focus on preventing further contractures. Stretching your fingers backward from the palm or placing your fingers at the edge of the table with palms down and then lifting the palm upwards gradually is one simple home remedy. Massage with lanolin cream and application of microwavable heat packs before stretching are also helpful. Most importantly, protecting the hands by building up handles with pipe insulation or cushion tape or heavy paddings for grasping tasks prevents the occurrence of further hand injuries and deformities.

If the palmar fibromatosis progresses severely that significant hand activities are interfered, then, conservative treatments are out. Here comes the more advanced and aggressive type. Generally, this kind of treatment aims to break or remove the cords or nodules that tighten the fascia and bend the fingers. The choice of procedure still depends on how worse the case is.

In Focus: Palmar Fibromatosis

Needling technique uses a needle, inserted through the skin, and acts to puncture or break the cord of tissue tightening the finger. A non-invasive option, it can also be done on several fingers at the same time and most often, little physical therapy is needed afterwards. Yet, chances of recurrence are high.

Likewise, enzyme injections involved injecting an enzyme towards the cord to soften and weaken it. Then, the doctor shall manipulate to break the cord and straighten the finger. Almost of the same benefits with needling, enzyme injection can be more painful initially.

Surgery is still the last resort if all things fail. It allows the doctor to surgically remove the affected tissues, liberate your palmar fascia, and straighten your fingers. Although, it promises a more complete joint release, recovery time and rehabilitation after surgery may take a longer time.

Palmar fibromatosis, Dupuytren’s contracture or whatever you call it, this hand-inflicting disease is indeed life-impacting. Remember, our hands no matter what size or looks they have, are still worth protecting!

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