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Dupuytren’s Contracture is a silent sculptor of the hand that gradually reshapes the palm and fingers into a clenched form. This condition weaves its way through the connective tissue beneath the skin, pulling the fingers into a gentle, yet stubborn, curl. Though it rarely causes intense pain, its presence speaks loudly in the language of limited functionality. Simple acts - such as grasping a cup, or extending a hand in greeting - become difficult to perform. This blog explores the causes, risk factors, and various treatment options, including physiotherapy, shockwave therapy, and steroid injections.
Causes and Risk Factors
Why Dupuytren’s contracture happens remains unclear, but studies have shown several risk factors that increase the likelihood of its development, including:
Genetics: The obvious one - genetics is a major player. Dupuytren’s contracture often runs in families, suggesting a strong hereditary component. People from Northern European descent are known to have a higher risk.
Age and Gender: It commonly affects individuals over the age of 50 and is more prevalent in men than women.
Lifestyle Factors: Excessive alcohol consumption and smoking have been linked to a higher risk, possibly due to their effects on circulation and tissue health.
Health Conditions: Dupuytren’s Contracture is more common in people with diabetes, epilepsy, or conditions that cause abnormal collagen production.
Manual Labor: While not a direct cause, repetitive hand trauma or heavy manual work may contribute to the progression of the disease.
Stages and Progression
Dupuytren’s Contracture usually develops slowly over years, progressing through distinct stages:
Early Stage: Small nodules or lumps form under the palm, often mistaken for calluses. The skin may feel slightly thickened.
Intermediate Stage: The nodules begin to form tight cords that extend toward the fingers, limiting their flexibility.
Advanced Stage: The affected fingers become permanently bent (contracted) toward the palm, significantly impairing hand function. It commonly affects the ring and little fingers.
Treatment Options For Dupuytren’s Contracture
Treatment options focus on improving hand function and slowing disease progression. The choice of treatment (surgical vs non-surgical) depends on the severity of the contracture, ranging from conservative approaches to minimally invasive and surgical interventions. Here are the available treatment options:
Non-Surgical Interventions
Non-surgical interventions can help improve hand mobility and slow progression for mild to moderate cases. However; more advanced form of the condition often requires a surgical modality to treat the condition.
Physiotherapy is one of the safe and effective non-surgical options to manage Dupuytren’s contracture - especially in earlier phases. Techniques include:
Stretching Exercises: Specific exercises such as finger and palm stretches help reduce stiffness and maintain flexibility.
Splinting: Custom splints may prevent further contracture, especially when worn at night. These help slow the progression of the condition by keeping fingers extended all the time.
Massage Therapy: Deep tissue massage may break down adhesions, improve circulation, and provide some relief from tightness.
Strengthening Exercises: Keeping the hand muscles strong can help maintain grip function. Resistance training with therapy putty or hand grippers can be useful.
Heat Therapy: Applying warmth to the affected hand can improve blood circulation and make stretching exercises more effective.
ESWT is a relatively new, non-invasive, and effective treatment option that uses high-energy sound waves to stimulate healing by breaking down the fibrous tissue and promoting blood flow. Shockwave therapy works by:
Breaking Down Fibrous Nodules and Cords: The shockwaves disrupt the excess collagen fibres responsible for contracture, potentially reducing stiffness and improving flexibility.
Stimulating Tissue Regeneration: By increasing blood circulation, shockwave therapy promotes the healing of damaged connective tissue, which may slow disease progression.
Reducing Pain and Stiffness: Although Dupuytren’s Contracture is not always painful, some patients experience discomfort, which ESWT can help alleviate.
In most cases, multiple sessions of ESWT are administered over several weeks. Research suggests that while it may not completely reverse contracture, it can improve hand function and slow disease progression. However, its success differs among patients, and optimal outcomes are frequently achieved when paired with physiotherapy.
Corticosteroid injections are the cornerstone non-surgical treatment option for most mild-to-moderate cases of Dupuytren’s contracture. They are used to reduce inflammation, slow the progression, and enhance mobility of the hand. These injections work by:
Reducing Inflammation: Corticosteroids help decrease swelling and discomfort associated with the formation of nodules.
Softening Thickened Tissue: The medication weakens the excessive collagen buildup, potentially preventing further contracture.
Providing Temporary Symptom Relief: While they do not cure the condition, steroid injections can delay the need for surgery and improve flexibility.
Steroid therapy is most effective in the early stages of the disease. It involves repeated injections directly into the thickened tissue. Side effects include skin thinning, temporary bruising, or mild discomfort at the injection site.
Surgical and Minimally Invasive Options
For advanced cases where the contracture significantly impairs hand function, surgical or minimally invasive treatments may be necessary:
Needle Aponeurotomy
A minimally invasive technique in which a needle is used to break the fibrous cords, restoring finger extension with minimal downtime. Compared to traditional surgery, this procedure allows for a faster recovery.
Collagenase Injections
An enzyme injection (collagenase clostridium histolyticum) is used to weaken and dissolve the fibrous cords. After the injection, the doctor manually straightens the fingers to break the contracture. Although less invasive, this approach is not appropriate for every case. The main advantage of this treatment is that it can be done in an outpatient setting with a shorter recovery period.
Surgical Fasciectomy
In advanced stages, open surgery is performed to excise the affected tissue. While this is the most definitive treatment, it involves a longer recovery period and a potential risk of recurrence. The procedure may involve removing part or all of the affected fascia. Post-surgery, patients typically require hand therapy to regain full function.
Rehabilitation and Long-Term Management
Regardless of the treatment approach, post-treatment care is crucial for maintaining hand function:
● Hand Therapy: Following surgical intervention, physical therapy and ESWT plays a crucial role in restoring mobility and strengthening the affected finger. A hand therapist may provide customized exercises to prevent stiffness.
● Ongoing Stretching: Regular stretching exercises can help prevent recurrence. Using tools like resistance bands or finger extension devices may help keep fingers flexible.
● Avoiding Risk Factors: Limiting alcohol intake and smoking may help slow disease progression by improving circulation and tissue health.
● Monitoring Symptoms: Regular check-ups with a healthcare provider ensure early detection of recurrence, allowing for timely intervention before the condition worsens.
● Using Adaptive Tools: Patients with long-term contracture can benefit from adaptive tools such as ergonomic grips for utensils and pens, which help reduce strain on the hand.
Conclusion
Dupuytren’s Contracture is a progressive condition that can significantly impact hand function if left untreated. Although there is no cure, non-surgical treatment options such as physiotherapy, shockwave therapy, steroid injections, and surgical interventions - can effectively manage symptoms and enhance mobility. No matter the choice (surgical or non-surgical) - early intervention is essential for slowing progression and preserving hand function. If you notice any signs of Dupuytren’s Contracture, consult a healthcare professional to discuss the best management plan for your needs.
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