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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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Trigger Finger Surgery

If you are likely to put severe stress on your hands on a daily basis then you might be prone to a condition which is called trigger finger. Basically, trigger finger is a condition that affects the fingers, specifically, the tendons that connect the fingers to the muscles of the hands. And individual with this condition is likely to experience some pain when moving the finger, this may happen in any five fingers. It will first cause numbness, swollenness and pain on the affected finger, as the condition is left untreated and continues to develop, there will be instances that the finger will be locked in a bent position. The affected individual may have difficulty in straightening the affected finger. In early stages, the lock will not last long and will be of a few seconds or moments, but if still continuously left untreated and the affected individual continues to perform severe activities that may cause stress and trauma to the hand and fingers, the individual will soon experience longer cases of locking. Furthermore, the finger may impose severe amount of pain upon movement.

The reason behind trigger finger lies beneath the tendons itself, our fingers our basically muscle-less meaning it depends on other muscles for its motor motions. The muscles that can be found in the hands and also in the forearms are mainly responsible for its motion, these are connected to the fingers with the structure called tendons, these are the string muscle like structure that are mainly responsible for the flexing and stretching of the fingers themselves. In short, the motion of the fingers are very dependent on the tendons, when the tendons are damaged, the finger’s movements are either eliminated or affected. In the event of a trigger finger, it mainly affects the tendons. The structures of the tendons include the tendons itself, covered by thin protective sheath and along the sheath, are lined with a structure called tenosynovium. The tenosynovium is a main structure of the tendon that is the key responsible in producing a lubricant that enables the smooth gliding of the tendon and the sheath itself. When the tenosynovium is inflamed, its capabilities to produce the lubricant is lessened or depleted, in this case, the lack of lubricant between the tendon and the sheath tend to result to a hard movement resulting in the lock of the finger during a trigger finger condition.

Trigger finger is a very treatable condition that can be cured in a number of ways. In earlier cases, this can be still treated through a non-surgical manner. Stopping all stressful activities that may affect the hands to give the inflammation some time to heal and recover. This can also be facilitated by a non-steroid anti-inflammatory drug like ibuprofen. Other than that, the use of a finger orthosis can be used in more developed cases, this will help stop the movement of the finger. The duration of how long the brace can be worn is usually prescribed by a doctor, depending on the severity of the condition. For some more developed cases, the use of stronger anti-inflammatory drugs like corticosteroid injections, which are steroid based shots, are used when the inflammation are already too severe. But in the cases of prolonged locks and pain during minor movements, trigger finger surgery is recommended.

The surgery mainly concentrates on removing the sheath that is constricting the movement of the tendon. There are two types, an open surgery release and a percutaneous release. By far, an open surgery is the most effective between the two but is more prone to complications and leaves a large scar. Basically, the process includes the application of an anesthetic on the affected finger, an open wound will then be done and removing the sheath. A percutaneous release, on the other hand, will no longer require the process of incision. It will require the use of a single needle that will be inserted on the affected area. This needle will then be used to separate the ligament that is constricting the tendon. This process takes place with the use of micro punctures. There would be no large scars left but is a very dangerous process. Neighboring the tendons are nerves that may be affected or damaged when not accurately performed

Trigger Finger Surgery

The treatment of a trigger finger does not end with the surgery itself. There are still precautions and a recovery process. The wound from the surgery will heal in a few days with a maximum of a week. Full movement will be back after a two-week period. Sports may be allowable after the first two weeks, but manual labor or more stressful sports like baseball, it is necessary to wait for a three week period. Patients who have undergone more than one simultaneous finger release surgery are more likely to have a longer healing period. In cases that the hands have been in severe conditions that led to stiffening of the fingers before the surgery, it is recommended that physical therapy may be applied to be able to improve the range of movement. Physiotherapy includes massage and minor finger movements, and occupational therapy, having a therapist to support you every day work to slowly help the hands development.

Surgery is not all of a safe procedure. There may be complications that would result. Minor complications like infection, pain and swelling that will heal over time. But there are cases that result in nerve damage causing lack of sensation in certain areas and are permanent effects. Tendons are placed in wrong positions also called as tendon bowstringing. Other than that, there is a small chance that the surgery is not at all effective, in an estimated of 3 percent of the cases, the trigger finger comes back.

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Finger Orthosis

Misalignment of the teeth, bad posture, and broken neck, all of these can be corrected with the use of braces. Orthosis is a type of device that is used to correct or support a part of the body. A finger orthosis is used in several different kinds of ailments or conditions, common examples of these are broken, fractured, or dislocated fingers. It is also used in correcting different finger contraction diseases like trigger finger. In the case of diseases like trigger finger, a finger brace is used for physical therapy in order to correct and prevent any further development to that contraction of muscles or tissues.

Finger Orthosis

There are a lot of finger braces that can be bought through the internet, ranging from the finger brace itself to some that are hand and finger support. Finger braces are made from a light but hard synthetic plastic. It ranges from sizes and lengths, it is used in any of the five fingers and is usually size managed to achieve full comfort. The design of it is not a simple straight tube but instead is partially arched to prevent stressing the joints too much or the part where the ailment is. The inner linings are also lined with a comfortable thin cushion to prevent irritation and to achieve comfort because a person is most likely to wear this the whole day. These braces are worn partially and not directly, to start off, an individual will start to wear this between 2 to 3 hours per day and increasing its duration in the process. This is in order to prevent over straining the tissue, especially in cases that deals with ailments of contracting muscles or tissues. While finger braces are not a type of treatment, this will guarantee to prevent further damage.

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Treatment for Contractures

There are instances that the human muscle may act weird, despite its ability to adapt and grow with the use of exercise and everyday activities. It is also capable in the process of shortening itself. There are cases that this happens resulting in the limited movement of a muscle or joint and worst cases suggest individuals who have lost total control of movement. A condition which results in the shortening of the muscle or joints is called a contracture. In this case, an individual suffering from this condition may experience a decrease in angle between joints like the arms coming closer to the body with the inability to have full control or just to have motion senses. This condition can happen in any part of the body, in the hands, arms or even legs. There are multiple other specific conditions that are related and caused by contractures like the Dupuytren’s disease which happens on the palms of hands and is caused by the shortening of a tissue that is found between the palms and the fingers. There are a number of reasons why this condition occurs.

Treatment for Contractures

Deformity, immobility, injury or chronic inflammation may be a seen cause of a contracture. Any trauma may trigger an abnormal activity within the affected joints or muscles. Other than that, there are in born causes like muscular dystrophy which is a degenerative disease of the muscles and cerebral palsy which is the impaired ability to control muscles. This condition though is not a permanent disease and can be relieved in a number of treatments.

A basic type of treatment for contractures is the physical therapy, it is much widely suggested that people who are suffering from the shortening of either muscle or joints to be more active, increasing the range of motion of the affected body parts. In this case, the shortening will be limited, lessened or controlled because of the continuous stretching that will counter act the development of the condition. Having an inactive lifestyle may only tolerate the progression of the disease without anything having to counter act its continual development. Physical therapy not only helps develop the muscles but also increases joint elasticity, counter acting the stiffening process.

Casts, splints and orthosis are also used to prevent the development of the condition. Casts in general help keep the affected joints and muscles in a more functional position. Helping to stretch and keep the joints and muscle in a non-tolerable manner. In this case, casts are usually repositioned from time to time to prevent stiffening of the muscles or joints. This usually used mostly in cases when the individual affected is unable to develop a sense of motion for himself, in short, he is immobile or have been in an accident. But there are also cases that braces are used with fully functional individuals like the Dupuytren’s disease, contracture of the hand, an orthosis is used to fully stretch the finger without the continuous effort of the affected individual. Other than manual treatment, mechanical treatment is also present, with the use of other devices to continuously manipulate the movement of muscles and ligaments, especially used after an operation to slow down the rate of shortening. There are also medications to help prevent the shortening of the muscles or tendons, steroid based medications primarily.

Treatment for Contractures

When all else fails, when basic treatments and medications are ineffective, the last resort of treatment considered is surgery. Surgery is used in contractures that have caused damaging effects on individuals, like the inability of motion and deformation. The surgery will primarily manipulate the affected joints or muscles depending on the affected area. Its main process is to separate shortening ligaments or muscles, in the case of Dupuytren’s disease, the shortening tissue is removed.

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