Understanding Dupuytren’s Contracture

Dupuytren’s contracture is a hand condition where thick, scar-like tissue bands form underneath the skin of the palm and pull one or more fingers into a bent position. It typically begins as a small lump or pit in the palm and slowly progresses over time. The bent fingers cannot be straightened fully and this causes difficulty with everyday tasks requiring full use of the hands.

Symptoms and Progression

Early symptoms include the formation of a tender lump or pit in the palm, most often at the base of the ring or little finger. As it advances, firm cords begin to form under the skin, pulling the finger towards the palm. In moderate cases, the fingers cannot be flattened fully and remain slightly bent. In more severe cases, the fingers are pulled into a 90 degree angle or more and gloves and mittens cannot be worn. Most often the ring and little fingers are affected first, then later the middle and index finger in more advanced cases.

One patient reported working with a man whose fingers were fixed at a 90 degree angle and the cords felt “very hard” and were impossible to straighten – “felt like it was going to break.” Despite 30 minutes of vibration therapy work, there was little improvement in that severe case. However, most other patients with Dupuytren’s do experience significant increased mobility after similar treatments.

Dupuytren’s tends to progress slowly over months and years. However, in some patients the cords thicken quickly and bend the fingers rapidly. It occurs most often in men over age 50 and usually affects both hands to varying degrees. Heredity may play a role as it tends to run in families of Northern European descent. Repeated hand trauma and tasks, smoking, liver disease and diabetes are also associated risk factors. Some patients report a connection between occupations requiring prolonged forceful gripping actions and the development of advanced Dupuytren’s.

Treatments

For early stage Dupuytren’s, corticosteroid injections may help slow progression. Splinting and therapy may provide temporary relief but do not stop its advancement. When the condition interferes significantly with hand function and finger movement, surgery or other procedures are typically recommended.

The traditional surgery is called fasciectomy, where the tight cords are cut and removed from the palm to allow the fingers to straighten. Recovery involves extensive hand therapy and takes 3-6 months for optimal results. More recently, less invasive procedures like needle aponeurotomy use a small needle to cut and help rupture the cords without removing tissue, enabling quicker healing. However, there is a higher recurrence rate over time.

Non-surgical vibration therapy is a newer alternative treatment being studied. It uses a handheld device that delivers vibration to the affected tissues with the aim of helping soften and potentially break down some of the hardened cords. One therapist treated a man whose fingers were fixed in a 90 degree bent position. Despite 30 minutes of vibration treatment focused on the entire contracture, there was little improvement in his severe, advanced case. However, the therapist reported most other Dupuytren’s patients do experience significantly increased mobility and straightening of the fingers after similar vibration therapy.

Research on vibration therapy is still limited but early results are promising for improving hand mobility without surgery in select cases caught early enough. One patient with advanced Dupuytren’s affecting all fingers had undergone multiple surgeries to sever the cords. Further vibration therapy was able to restore some additional mobility for improved function.

Conclusion

Dupuytren’s contracture is a progressive hand condition that impairs finger mobility. Close monitoring and timely treatment are key to helping restore hand function. Consulting an experienced hand specialist is recommended to determine the most appropriate options based on severity, impact on daily living, and patient factors. A combination approach of procedures, stretching, and therapy may provide optimal long-term results.

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