Dupuytren's contracture is an alteration that occurs in the palm of the hand that makes one finger always more folded than the others. This disease mainly affects the men, from the 40 years of age and the most affected fingers are the ring and the pinky. Your treatment is done through physical therapy, but in some cases surgery may be necessary.
This contracture is benign but can bring discomfort and hamper the day-to-day of the affected person, causing pain and difficulty to open the hand completely. In this case small fibrotic nodules are formed which can be felt by pressing the palm of the hand. As they increase, Dupuytren's nodes develop small cords that extend causing contracture.
Causes of Dupuytren's contracture
This disease can be hereditary cause, autoimmune, may appear due to a rheumatic process or even due to the side effect of some medicine, such as Gadernal. It is usually caused by the repetitive movement of closing the hand and fingers, especially when there is vibration involved. People who have diabetes, smoke, and drink alcohol in excess seem to have a greater ability to develop these nodules.
Symptoms of Dupuytren's contracture
The symptoms of Dupuytren's contracture are:
- Nodules in the palm of the hand, which progress and form 'ropes' in the affected area;
- Difficulty in opening the affected fingers;
- Difficulty in laying the hand properly open on a flat surface, such as a table.
The diagnosis is made by the general practitioner or orthopaedist, even without the need for specific tests. Most of the time the disease progresses very slowly, and in almost half the cases the two hands are affected at the same time.
How to treat Dupuytren's contracture
Treatment can be done with:
1. Physiotherapy
The treatment for Dupuytren's contracture is done with physiotherapy, where one can use anti-inflammatory resources like laser or ultrasound, for example. In addition, joint mobilization and the breakdown of collagen type III deposits in the fascia, either through massages or the use of appliances, such as the hook, are used as a fundamental part of the treatment, using a technique called crocheting. Manual therapy is able to bring relief of pain and greater malleability of tissues, bringing greater comfort to the patient, improving their quality of life.
2. Surgery
Surgery is particularly indicated when the contracture is greater than 30º in the fingers and greater than 15º in the palm of the hand, or when the nodules cause pain. In some cases the surgery does not cure the disease because it can recur years later. There is a 70% chance of the disease coming back when one of the following factors is present: male sex, onset of illness before age 50, having both hands affected, having first-degree relatives in northern Europe and also having affected fingers. However, surgery is still indicated because it can bring relief of symptoms for a long time.
After the surgery, physiotherapy is necessary, and a splint is usually used to keep the fingers extended for 4 months, which should only be removed for personal hygiene and physical therapy. After this period, the doctor may re-evaluate, and reduce the use of this immobilization splint for use only during sleep for another 4 months.
3. Collagenase Injection
Another less common form of treatment is the application of an enzyme called collagenase, derived from the bacterium Clostridium histolyticum, directly into the affected fascia, which also achieves good results.
Avoiding closing the hand and fingers many times a day is a recommendation to be followed, if necessary, a stop at work or a change of sector is recommended if this is one of the causes of the onset or worsening of the deformity.
