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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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Flexion Contracture Hand

Like any other body part, the hand has tissues and these tissues are the key why we are able to successfully perform both basic and integrated motor skills. Like any other body part, the hand can suffer from a flexion contracture. A flexion is a position made by decreasing the angle, in the case of the hand, decreasing the angle between the finger and the palm. A contracture, on the other hand, is a state in which there is either the shortening or hardening of the muscles or tissue. As the name suggests, a flexion contracture hand is when the angle between the finger and the palm decreases while the tissue in between them shortens and hardens. The result would be a disease called Dupuytren’s syndrome which results to the fingers, usually the pinky and ring finger, coiling closer to the palm. It also results to the inability of the fingers to be fully straightened and, in worst case scenarios, have fully terminated the ability of the fingers to be productive and to perform even basic motor skills.

Flexion Contracture Hand

Flexion contracture of the hand is usually seen as a heredity disease, as for the moment. The commonly seen cause of this disease is through being present in the bloodline. Though, it is also being studied on other causes that may have triggered this ailment, namely relating traumas and aging with people who have the disease. In a recent study, it has been seen that the tissue that is tightening showed minor bleeding that can be related to traumas caused by hard manual labor. Regarding that, a percentage of the people having this disease have claimed that they have done severe work like hard sports utilizing the hand and construction work. The disease though cannot be fully treated, but instead can be only controlled. Developing cases can be injected by cortisone to slow or to momentarily stop the development. In severe cases, surgery is an option, but the disease will again develop in 3 to 5 years.

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Dupuytren’s Contracture Surgery

Dupuytren’s contracture, Dupuytren’s Disease, Morbus Dupuytren or Palmar Fibromatosis causes flexion contractures on the hands where fingers flex towards the palm and can’t be fully straightened or extended. The disease was named after Dupuytren, Guillaume, a surgeon who was the first to describe the surgical correction for the condition. Dupuytren’s Contracture Surgery is a common treatment method for this condition.

The disease is due to the abnormal thickening of connective tissues under the skin. Such thickening is known as Palmar aponeurosis or fascia. Such thickening takes place at the palm of your hands and extends to the fingers. Lumps and firm cords may accumulate and cause the bending of fingers from behind and towards the palm.

The development of the condition may also involve the skin and other deep sutures-like tendons – although not directly. The disease will occasionally thicken at the top of the finger’s knuckles or knuckle pads, cords, or nodules inside the plantar fibromatosis or soles of the feet.

Cause of Dupuytren’s Disease

What exactly causes Dupuytren’s Disease still remains a mystery. Certain bio-chemicals inside the affected fascia have been associated to it. Specific associations have also been linked to:

  • Northern or Scandinavian ancestry. It has been called “Viking’s disease,” and in certain Mediterranean countries like Bosnia, Spain and Japan.
  • Men at the age of 40 years and above. Statistics revealed that men have ten times more tendency to get the disease than women.
  • Family history and ancestry. 70% of the cases have been associated to genetic predisposition of the disease.

Though not conclusive, Dupuytren’s contracture is also associated to diabetes, trauma, tobacco use, alcoholism, phenytoin and liver disease treatments in epilepsy.

Specific occupations and hand injuries have been suggested to increase the risks, although no conclusive evidence supports the suggestion. The disease may be triggered by manual labor and over-exertion of the hands which can cause trauma to certain areas of the hands. The disease though doesn’t always take place on the dominant hand and has nothing to do with right or left handedness.

Signs and Symptoms of Dupuytren’s Disease

With Dupuytren’s disease, connective tissues of the hands become unusually thick and such thickness causes the furling of the fingers and result in impairing the function. The ring and index fingers are the ones that are usually involved. In some instances, both of the hands get it, though the extent may differ in both hands.

Symptoms for Dupuytren’s Disease involve the formation of cords, bands, pits, and lumps inside the palm. Progression can’t be predicted. A number of individuals will only have small cords and lumps while others develop bent fingers. Individuals with serious conditions will experience the symptoms at an early age.

The disease generally begins with a minimal and tender lump within the palms. Such discomfort is not yet a burden and the disease isn’t really painful. In due time, hard bands may develop on the tissues which should be visible on the palm’s surface and appear like a small callus. The nodules or lumps then become adherent and firm over the skin.

As fascial bands become thick, they will form cords that will extend from the palms within one or more of the fingers and cause bending or tethering and contractures over the fingers. This causes the reduction of mobility which is commonly linked to the condition. Such cords may also sometimes be mistaken as tendons though they lie in between the tendons and skin. The disease can first be observed when the individual finds it difficult to put his hand flat over a flat surface like a tabletop.

Contractures develop very slowly in women. But serious conditions progress faster and affect both hands which can be associated to the foot. As the disease develops, patients will experience difficulty in doing simple activities like washing up, shaking hands, adjusting their hands inside the pocket and wearing gloves.

Surgery as Treatment

Dupuytren’s Contracture Surgery

Surgery may be necessary in a number of cases and definitely needed on serious cases that involve the knuckle or metacarpophalangeal joint, fast progression and difficulty in motion and functionality. It is the aim of surgery to eliminate the lump of tissue on your palm. This could be a challenge because it’s very hard to determine the tissue in its early stage. The tissue may also connect towards the skin and make it hard to eliminate and increase the chances of regeneration.

What’s good about surgery though is that the complete joint is released more than what an enzyme or needle can provide. Physical therapy may be required right after surgery and recovery may take more time to take effect. Skin grafts may also be required on an occasional basis to cover up the wounds after an extensive removal of the affected tissue.

Needling

The technique uses needles inserted in the skin to break and puncture the tissue cord that contracts the finger. Contractures usually recur but the process can be done again. A number of doctors use ultrasound to direct the needle. This will also reduce the chances of acquiring injury on the tendons and nerves.

The good thing about needling technique is that there are no incisions involved. It can be applied on fingers and generally little therapy is required after the procedure. It can’t be used on certain locations within the fingers because it may disembowel a nerve.

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