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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 Disease Treatment

Dupuytren’s disease is a condition whose cause is uncertain. The condition is manifested by a hard lump of skin that usually forms on the fingers. The connective tissue accumulates over the palms of both hands although one hand may be more affected than the other. The disease begins with a local accumulation but then spreads to other parts of the body as it develops in the later years. The disease is usually observed to affect the middle and ring fingers although the index finger may be affected as well. Dupuytren disease treatment can be administered to individuals with severe cases of the disease.

Theories on the Cause of Dupuytren’s Disease

Dupuytren Disease Treatment

Many researchers are now thinking that the lump of connective tissue is the product of the medications taken by epileptic patients. Such medications, as they observe, make the individual more vulnerable to having Dupuytren’s disease. Epileptic medications increase the production of components that trigger the formation of the condition.

Age also seems to be a significant factor because people aged 30 to 40 seem to be more susceptible to the disease than other age groups. If certain areas of the hands such as the palms and fingers are affected, it will be difficult for the individual to move his fingers or use them.

Causes and Mechanisms of the Disease

There are several theories as to what causes the disease but all of the theories are still inconclusive. It has also been observed that the condition develops gradually over time. It’s very difficult to determine its symptoms because the whole development is painless. The most obvious symptom is the inability to move your fingers properly.

The tissue itself is non-cancerous and usually non-traumatic. The connective tissue grows over and under the skin of the palms, affecting some of the tendons along these areas. It will be difficult for the patient to do certain tasks with the hand like holding a glass of water in place or grabbing something out of his pocket. These are some of the worst cases. The connective tissue is sensitive but it would be painless.

Painless but Troublesome Condition

Individuals with Dupuytren’s disease seek medical attention not because of pain but because of the difficulty to do basic chores using the hands. Because the cause of the condition and its accumulation isn’t well understood, physicians have to try and treat the disease empirically. Surgery though, is one of the most effective treatments used under such circumstances.

Therapy May be Used

Dupuytren Disease Treatment

Therapy may be used to help patients become more mobile with their fingers. Oftentimes, education with regards to the disease is enough. Surgery is recommended in the long-run if cases are beyond therapy and deformities start to form. If you don’t like surgery, then your best alternative is prevention although the disease may recur from time to time and never completely eliminated.

The Goal of Treatment

It is the aim of treatment to improve the positioning of the fingers, allow it to open or close and improve the functioning of the hands. In less severe cases, where the condition is gradually developing, pain will not be felt and the functioning of the hand will not be affected. Regular assessment will still be required in the process. With severe cases however, a number of treatment options for straightening affected fingers are important. This treatment involves the breaking or removing of cords that pull your fingers to your palms.

In your initial consultation, appropriate treatments will be based on the pattern and stage of your condition and which of the joints are affected. Before commencing treatment, it is crucial to set realistic aims and talk about possible results and risks.

The Disease May Recur Even after Treatment

It is also vital to take note that permanent cure for the disease has not been discovered yet. In spite of treatment, the disease may recur in the long run. The important thing here is to maximize the functionality of your hands during the various stages of the disease.

There are various ways of straightening the fingers and releasing the contractures. Such treatment options may include minimal needling techniques like needle aponeurotomy or percutaneous needle fasciotomy, conservative measures like splinting, and open surgery or fasciectomy.

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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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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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