Dupuytren’s Contracture

THE CLINICAL SYNDROME

Dupuytren’s contracture is a common complaint encountered in clinical practice. Although it is initially painful, patients suffering from Dupuytren’s contracture is caused by a progressive fibrosis of the palmar fascia. Initially, the patient may notice fibrotic nodules along the course of the flexor tendons of the hand that are tender to palpation. These nodules arise from the palmar fascia and initially do not involve the flexor tendons. As the disease advances, these fibrous nodules coalesce and form fibrous bands that gradually thicken and contract around the flexor tendons, which has the effect of drawing the affected fingers into flexion. While all fingers can develop Dupuytren’s contracture, the ring and little finger are most commonly affected. If untreated, the fingers will develop permanent flexion contractures. The pain of Dupuytren’s contracture seems to burn itself out as the disease progresses.

Dupuytren’s contracture usually affects the fourth and fifth digits in males over 40 years of age.

Dupuytren’s contracture is thought to have a genetic basis and occurs most frequently in males of northern Scandinavian descent. The disease may also be associated with trauma to the palm, diabetes, alcoholism, and chronic barbiturate use. The disease rarely occurs before the fourth decade. The plantar fascia may also be concurrently affected.

SIGNS AND SYMPTOMS

In the early stages of the disease, hard fibrotic nodules along the path of the flexor tendons may be palpated. These nodules are often misdiagnosed as calluses or warts. At this early stage, pain is invariably present. As the disease progresses, the clinician will note taut fibrous bands that may cross the metacarpophalangeal joint and ultimately the proximal interphalangeal joint. These bands are not painful to palpation, and while they limit finger extension, finger flexion remains relatively normal. It is at this point that patients will often seek medical advice as they begin having difficulty putting on gloves and reaching into their pocket to retrieve keys. In the final stages of the disease, the flexion contracture develops with its attendant negative impact on function. Coexistent arthritis, gout of the metacarpal and interphalangeal joints, and trigger finger may also be present with Dupuytren’s contracture and exacerbate the pain and disability of Dupuytren’s contracture.

TREATMENT

Initial treatment of the pain and functional disability associated with Dupuytren’s contracture should include a combination of the nosteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors and physical therapy. The use of physical modalities including local heat as well as gentle range of motion exercises should be introduced several days after the patient undergoes the following injection technique. A nighttime splint to protect the fingers may also help relieve the symptoms of trigger thumb. Vigorous exercises should be avoided because they will exacerbate the patient’s symptomatology.

Injection of Dupuytren’s contracture is carried out by placing the patient in a supine position with the arm fully adducted at the patient’s side with the dorsal surface of the hand resting on a folded towel.

The aforementioned treatment modalities are useful in providing symptomatic relief of the pain and disability of Dupuytren’s contracture. However, most patients will ultimately require surgical treatment of this syndrome. This injection technique is extremely effective in the palliation of pain and dysfunction secondary to the Dupuytren’s contracture.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.