Managing Dupuytren’s Contracture

dupuytren_fcmMany people may be dealing with a common debilitating disease of the hand called Dupuytren’s contracture. This problem is caused by a progressive contracture (shortening) of the palmar fascia that produces flexion deformities of the fingers. The cause of this disease is unknown with onset usually between the ages of 50-70, men are affected more that women. The disease is present in various cultural groups but primarily affects individual of Northern European descent. Although the cause is unknown the condition is associated with chronic alcoholism, hypothyroidism, seizure disorders, diabetes mellitus, chronic pulmonary disease, and smoking.

Dupuytren’s contracture usually begins as a tender nodule in the palm (most commonly at the ring and little fingers) followed by the appearance of tendon-like cords (thickening/shortening of the palmar fascia) which leads to a flexion contracture of the first and second joint of the fingers. The nodule may initially cause discomfort but becomes painless as it matures. Symptoms consist of painless thickening of the palmar skin and underlying fascia with dimpling and/or formation of nodules.

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Non-operative treatment for this condition includes splinting, vitamin E, and ultrasound but have limited to no affect depending of the severity of the disease. Steroid injections have been effective in early treatment of the nodules. Surgical intervention is considered the best approach and is usually recommended when the first finger joint is contracted 30 degrees, producing functional restrictions in the use of the hand.

Therapy after surgery may assist with edema control, promote wound healing, control scar formation, and recover hand function. For information on the physical and occupational therapy services offered by the Vereen Team, visit them online at www.VereenCenter.com or call 229-890-3553.

(Contributed by Chris Stroh, OTR/L, CHT)