Tag Archives | scar tissue formation

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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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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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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