The exact cause of Dupuytren’s contracture is unknown. It is a disease of the fascia of the palm and digits. The fascia is the layer of the connective tissue that binds the soft tissue structures – muscles blood vessels, nerves and tendons – of the hand and keeps them in place. A bit like the glad wrap keeping a sandwich together. The disease causes growth of cords and bands in the hand that affect the ability to move the fingers or thumb.
As a result the cords can grow, sometimes around the tendons and pull the fingers into the palm, restricting the fingers from being able to fully straighten, It starts with a nodule that you can feel and see in the palm and can grow thicker and larger, with visible cord like bands making the hand tight. The rate of growth varies. In some cases it can affect the feet and men’s genitals, especially if it begins before 50 years of age.
Who Can Get Dupuytren’s Contracture?
Dupuytren’s Contracture most commonly affects Caucasian males of Northern European and Scandinavian descent. Men are affected more frequently than women, as high as a 10:1 ratio.
Other conditions that have high association with Dupuytren’s Contracture include diabetes, chronic alcoholism, epilepsy, smoking, pulmonary disease and HIV. It commonly affects both hands. The ring and little fingers being the most frequently affected, though the thumb and other fingers can also be involved.
Different studies show varying rates but the prevalence of Dupuytren’s Contracture is about 3-6% of the general population.
What Treatment Is Available?
As early as last year, an injection became available in America and this year in Europe, that weakens the cords and allows them to be broken up. However, as the nodules or diseased tissue is not removed, the risk of the chords regrowing remains.
Historically, there has been little change with splinting or exercises using non-invasive therapy methods.
The most commonly used approach to correct Dupuytrens Contracture is to remove the diseased tissue surgically. The surgery then requires almost immediate and strict follow-up with a hand therapist. Splinting to maintain full straightening of the finger, wound care, swelling management, early movement and scar management are really important. There is no value in having the surgery and then not continuing on with the recommended hand therapy treatment.
Surgery is indicated when a thorough assessment is done by a Hand Surgeon. Referral from your local doctor to the specialist can determine if you are an appropriate candidate.
What Does Hand Therapy Involve?
In our experience, the best chance of a good outcome is achieved with the following:
Initial visit 2-3 days post-op.
Fabrication of a removable splint with fingers/thumb in full extension. The splint is mainly worn at night, depending on the extent of surgery, more frequent wear time may be indicated.
Night splinting up to 3 months, depending on progress.
Wound care and removal of stitches.
Scar management to reduce the chances of scar tissue limiting return of movement.
Early movement exercises from the first visit.
Methods to reduce and minimise any swelling.
Progress to strengthening after the wound has fully healed and resistance can be tolerated.