Treating Dupuytren's Contracture

Dupuytren's contracture is a deformity of the fingers and hand that most often occurs in individuals over fifty years old. Typically, the deformity develops gradually over several years. The most common early signs of the condition are a skin thickening or lump on the palm of the hand. As the contracture reaches later stages, several lumps or knots may form and draw the fingers into a permanently curled position. Typically, this occurs with the ring and little fingers. Recent estimates suggest approximately seven percent of Americans have Dupuytren's contracture. Researchers believe up to thirty-three percent of those individuals may go on to develop bent fingers. While the exact cause of Dupuytren's contracture is currently unknown, the disorder is more common in males than in females. In particular, men of Northern European descent are believed to have an increased risk, and it is for this reason the disorder is sometimes called Viking's disease. Having diabetes or epilepsy, smoking, and consuming alcohol may exacerbate symptoms. Let's look at some treatment options that may be beneficial for patients with Dupuytren's contracture now.

Needling

Officially known as needle aponeurotomy or percutaneous needle fasciotomy, needling is a minimally invasive technique that can be performed by a doctor to straighten and restore function to fingers affected by Dupuytren's contracture. The outpatient procedure can be performed at a healthcare provider's office and typically takes around half an hour to complete. The doctor will numb the patient's hand before beginning the procedure. Once the local anesthetic is working, the doctor will place a needle into the lumps or bands of tissue that are curling the fingers down, making holes in the tissue. Next, the doctor will pull the fingers into a straightened position, destroying the knots of tissue and allowing the patient to use their fingers normally again. Patients may need physical therapy after needling to maximize finger function, and their doctor may also want to give them steroid injections. In certain cases, the procedure may need to be repeated if the tissue regrows. If tissue grows back, it generally does so approximately three years after this procedure.

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Enzyme Injections

The tissue that forms the contractures is made of collagen. The enzyme collagenase destroys collagen, and it has been regularly used since 2010 as an injectable medication that weakens the knots and cords of Dupuytren's contracture. The non-surgical procedure involves having several injections of the enzyme during one office visit. The enzyme then works to weaken the tissue overnight, and the patient returns the following day to have their fingers manipulated into a straight position by the doctor. This treatment must be administered by a healthcare professional who has received specific training with this medicine. It is most commonly given by hand surgeons or orthopedic specialists. Enzyme injections are a conservative way to manage the symptoms of Dupuytren's contracture and can help restore finger mobility.

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Surgery

As with many conditions, an operation for Dupuytren's contracture is only recommended as a last resort if other treatment methods have been unsuccessful. Patients with early or middle stages of this condition may find relief with nonsurgical options, while surgery may be necessary to relieve severe symptoms and restore finger function and mobility. The operation for Dupuytren's contracture may be either limited or radical depending upon the severity of the symptoms. In very severe cases, surgeons may need to remove all of the affected tissue, and a skin graft may be needed. While the condition may reoccur following surgery, surgical methods can provide more effective relief than conservative treatment and a longer window of time free of symptoms. In general, patients can expect to have five years post-surgery before the contractures are likely to regrow. The recovery time after this operation varies, and patients may need to use a hand splint. Frequent physical therapy is also needed for several months after the procedure.

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Limited Fasciectomy

There are many variations to a limited fasciectomy, and the specific on used depends on the severity and progression of the patient's condition, though the goal is always the same. During this procedure, the thickened part of the fascia tissue is surgically removed to restore mobility and flexibility to the patient's fingers. The surgeon will operate through the palm of the hand, making incisions into the fascia tissue. Once inside, they will cut away the thickened cord. If the skin attached is also removed, a graft will be used to cover the wound. The incision is then closed with stitches and bandaged, and a splint is applied to provide support to the patient's fingers. While the procedure is straightforward, there is always a risk of complications, such as an infection, skin discoloration, scarring, and a rejected graft.

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Radiation Therapy

Dupuytren's contracture can also be treated using radiation therapy. In fact, medical journals have discussed its utility as far back as the 1930s. The logic behind this treatment is radiation works as an anti-inflammatory. However, its difficult to quantify the results of studies accurately due to the unpredictable nature of Dupuytren's contracture and its progression. Radiation is typically used to prevent the disease, rather than being effective in treating it. There is evidence that shows radiation can reduce tenderness, firmness, and itching in the nodule growths that characterize Dupuytren's contracture, though whether this slows down the rate of progression is still unclear.

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At-Home Remedies

It is important for patients experiencing any symptoms of Dupuytren's contracture to be properly evaluated by a doctor, preferably by an orthopedic or hand surgeon. If a healthcare professional agrees, certain at-home remedies can be used to alleviate pain and other symptoms of the condition. These remedies should only be used with appropriate medical guidance. Stretching exercises demonstrated by a physical therapist or doctor can be very useful for mild cases of Dupuytren's contracture.

Wearing heavy gloves while doing home tasks like repairs or gardening can help keep Dupuytren's contracture from getting worse and can improve comfort. When using hammers or other tools, cushion the handles with tape or other materials to avoid the need for an overly tight grip. Doing yoga or exercises with elastic bands can help relieve the hand and finger pain caused by Dupuytren's contracture. Using warm compresses may provide pain relief, and peppermint oil is believed to have anti-inflammatory properties that can soothe this condition. The use of a splint may provide support to the hand. However, improper splinting techniques, such as binding too tightly or for too long, can cause significant damage and may not be appropriate for all cases. Splinting should only be done if advised by a healthcare professional.

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Postoperative Care

After undergoing surgery to correct the tendons in the hand, proper postoperative care is crucial for safe, hygienic recover. The dressing will be removed by a doctor between three and six days post-surgery. Stitches are typically removed around two weeks after the procedure is done. However, in situations in which a skin graft was necessary during surgery, the wound will take longer to heal. The wound may still be a bit moist at this time, but it's very important to gently wash it with soap and water regularly to prevent infection. Once the stitches are removed and the wound is no longer at risk of splitting open, patients should complete light physical therapy exercises to stretch out the newly freed hands and fingers.

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Prevention Tips

While more research is required to completely understand Dupuytren's contracture, the following general hand health and lifestyle advice is beneficial. To keep hands and fingers as healthy as possible, wear protective gloves when working with vibrating machinery, and wear gloves in winter to avoid frostbite. Adopt a healthy diet that is low in inflammatory foods and includes lots of fruit and vegetables as well. Use ice packs or warm compresses if you experience any hand or finger strain, and take breaks when doing repetitive tasks such as typing or playing a musical instrument. Other prevention tips include managing diabetes, a major risk factor for Dupuytren's contracture, and trying to quit smoking, which can limit circulation and may lead to reduced blood flow to the hands, causing pain.