Dupuytren’s disease is a condition that causes one or more fingers to bend towards the palm of the hand.
It is caused by the thickening and scarring of the connective tissue (fascia) under the skin in the palm of the hand, which can form nodules or cords that can restrict finger movement to open the hand.
The disease is named after Guillaume Dupuytren, a French anatomist who first described it in 1834.
There is no cure for Dupuytren’s disease, but there are several treatments that can help to improve finger function and reduce pain and discomfort.
The most common finger you will see pull downward is the ringer finger, then the small finger. The palm will look and feel thicker in the middle of the palm or towards the small finger side of the palm. It can also affect the thumb.
Treatment options and recommendations have changed over the past 10-15 years.
There are several treatment options available for Dupuytren’s disease, including non-surgical and surgical options.
When I started over 20 years ago as an occupational therapist, it used to be recommended that you wait until it’s bad enough that it gets in the way of your function. For example, with Dupuytren’s disease, you don’t have a problem making a fist. Your problem becomes you can not open your hand enough so that your fingers get out of your way to be smooth in your everyday hand use.
One of my patients from years ago told me the reason he finally decided on hand surgery was because everytime he would reach for his beer, his hand could not open all the way, it would knock the beer off the table.
He got tired of feeling annoyed from knocking over his beer and other things I’m sure when it came to using his hands. When I met him, he was in his 70’s and had waited decades before treating his hands.
The recommendations for how and when to treat Dupuytren’s has changed in the past 10-15 years but here’s a list of a few options.
Non-surgical options include:
A splint can be worn to help keep the affected finger straight and prevent it from contracting.
2. Occupational/hand therapy:
Stretching and other exercises may help to improve range of motion and reduce symptoms of Dupuytren’s disease.
An injection of enzymes can be given to dissolve the thickened tissue in the hand. This is usually done in a series of injections over several weeks.
A needle is used to puncture the thickened tissue, which can help to break it up and improve range of motion.
Surgical options include:
1. Fasciectomy: This procedure involves the removal of the thickened tissue in the hand.
2. Dermofasciectomy: This procedure is similar to a fasciectomy, but it also involves the removal of the skin overlying the thickened tissue.
3. Needle fasciotomy: This procedure is similar to needling, but it involves the use of a special instrument to break up the thickened tissue.
4. Collagenase injection: This is a newer treatment option in which an injection of an enzyme is used to dissolve the thickened tissue.
Here are signs to look or, treatment options, and timeline to seek treatment from a certified hand therapist with decades of experience.
● MP and PIP joint contracture
● tightness and pain
● early is the easiest treatment
Does Dupuytren’s disease cause pain?
Generally speaking, Dupuytren’s disease does not cause pain.
What causes the pain is when the cords start to grow and thicken, it pulls the fingers down at the big knuckle (the MP joint) which then leads to an imbalance of how the hand needs to function.
Over time due to compensatory patterns, people with Dupuytren’s start to feel hand tightness and wrist tightness. Ignored and left untreated becomes this constant tightness and at worse, painful.
The progression of the disease can be slow but follows a particular pattern majority of the time. The cords pull down the big knuckle (the MP joint), then if it’s progressive, it will start to pull down at the middle knuckle (the PIP joint).
When to seek medical treatment?
The best time to seek medical treatment is before it starts to pull down the PIP joint. Once you see that it starts to pull down at the PIP joint, find a trusted hand surgeon that can help you.
I’ve worked with clients who have had enzyme injections, needle injections, and various degrees of open fasciectomy. Each option is based on the level of severity of the disease and the person’s desire to avoid open procedure.
The most common surgical procedure now is the in office collagenase injection using an enzyme and then the cords are broken by the doctor. Once the PIP joint is affected, this is not a real option anymore.
Occupational therapist and certified hand therapist can fit you with a custom fitted splint that helps you with your particular Dupuytren’s contractures. I don’t generally recommend prefab splints just because each hand is different as the cords develop with various levels of severity.
A splint can be useful either before or after a surgical procedure. Talk with your occupational therapist or certified hand therapist to consider the best option for you.
The best time for occupational therapy treatment is early after a procedure. By early treatment, I’ve treated people the same day for various injections. Post surgery at 5 days post-operation.
The best case scenario for Dupuytren’s is to avoid an open fasciectomy type of procedure. It can’t always be avoided but there’s options for you to try.
If you know you have Dupuytren’s disease and are wondering if therapy can help you then it’s time to give us a call and get clear if occupational therapy/hand therapy can help.
Request a Discovery Visit today and speak with our specialist. Stop wondering and just get answers.
Written by Hoang Tran
About the author – Hoang Tran; an expert in physical & occupational therapy
Hoang Tran is a certified hand therapist, the owner of Hands-on Therapy Services, and the author of the book “The Hands-On Approach”. She loves helping people with hand, neck, and shoulder problems because she knows how bad and debilitating they can get if not addressed and treated properly (once and for all!).
The aim of her Miami occupational therapy practice is to bring patients back to full functionality, without pills, injections, or surgery. Occupational and Physical Therapy are both offered at Hands-On Therapy by our experienced therapists who provide a comprehensive approach to your care.
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