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Gently and Surely: Finger Contracture Release 101

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.

Gently and Surely: Finger Contracture Release 101

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.

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Finger Contracture Cushion for Care and Comfort

Ronald Reagan and Margaret Thatcher are not only famous world leaders. They are some of the prominent personas inflicted with Dupuytren’s disease. Many people would not have the chance to become as popular and historic as Reagan and Thatcher, but everyone is equally at risk of developing the disease – just like them!

Dupuytren’s disease is just one of the many medical conditions which can cause hand flexion – the inability to fully straighten one’s fingers. Most often, scar tissue formation creates a cord-like bundle onto our fascia – just under the skin of our palm. The cord makes the fascia thicker and shorter, thus, our fingers and palm get closer. Hands that are constantly flexed are prone to skin tissue breakdown, worsening of the contracture and further deformities. Thus, various finger contracture cushions are available in the market that may come from different advertising promos but of one goal: to promote contracture resolution, care and comfort.

Finger Contracture Cushion for Care and Comfort

Finger contracture cushions are one of the various assistive devices that can be used to correct contractures. There are many commercial products available over the counter or just anywhere, but it is highly advisable that the experts must be consulted. A physical therapist usually makes the recommendations on what the best finger contracture cushion is for an individual, depending on his condition. Oftentimes, patients with Dupuytren’s disease are advised to wear this assistive device for an extended time. Since it gently separates the fingers and prevents them from pressing against the palm, a padded and adjustable type is highly preferred. There are also available products which can be made according to the patient’s wrist and fingers’ size – so it would be more personalised and suitable for the patient. Persons with rubber latex allergy should be more cautious in buying a product – polyester made, and latex free should be the choice. Significantly, finger contracture cushion should be washable, to maintain its cleanliness.

Finger contracture cushion is in some way a motion – restricting device. Preventing friction between the fingers and the palm, which usually happens with patients of contracture problems and Dupuytren’s patients in particular, shall avoid skin breakdown and further muscle shortening. Yet, precautions should be raised in using this device, as it may also impede circulation if used incorrectly. In applying finger contracture cushion, specific instructions manual that comes with the product should be taken into serious consideration. Generally, when applying it, the fingers should be in the neutral position. Once applied, the thumb should be positioned slightly away from the hand and at a moderate angle to the fingers, while the fingers are kept in a slightly neutral position rather than a tight fist. As pressure ulcers may occur due to excessive use of the device, removing this every 2-4 hours is very important to promote proper blood circulation.

While it does not take to be another Reagan or Thatcher to get inflicted with any contracture disease, it also would not take any powerful persona to resolve contractures and promote hand comfort and care with the use finger contracture cushion.

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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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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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Fingers Curved, Thumbs Down: Hand Contracture Causes

Imagine not able to grasp, grip, hold or even perform a high five? Yes, hand contracture can be as horrible as not being able to do anything – with your hands. Aside from these inabilities, social stigma may rise because of the bizarre hand flexion. What are hand contracture causes and what are the chances that we can have them treated?

A contracture is the shortening of particular tendons, muscles or other connective tissue, resulting to the inability to fully extend or straighten affected joints. Hand and finger contractures are often related to Dupuytren’s contracture. Usually develops over the years, this disorder affects a layer or bundle of tissues under the skin of your palm. Abnormally, these tissues mutate and change and form a tick cord the can pull one or more of your fingers and making it bent. Once this happens, the affected fingers cannot be fully straightened which can be very evident when you place your hands on your pocket, put on gloves or even when you shake your hand.

Fingers Curved, Thumbs Down: Hand Contracture Causes

The exact cause is unknown. But most researchers conclude that it can be associated with an autoimmune reaction – atypically, a person’s immune system attacks its self, tissues and creates a cord. Various factors are also associated with the contracture that increases one’s risk of having it. People aging 40 and above are at higher incidence to acquire it, as symptoms fully occur at this age. Men are more likely to have it than women. Checking your family history about this may also help, since it runs in families, especially those of Northern European descent. Diabetes patients should also take precautions since they have increased risk. Most of all, smokers and alcoholics, must think ahead because smoking chemicals and alcohol may initiate cell mutation.

Hand contracture causes may still be unfamiliar but these risk factors keep us aware of how close we are in acquiring the disease. The last thing we would want is having those topsy-turvy fingers!

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