- Causes of Dupuytren's contracture
- Symptoms of Dupuytren's contracture
- How to treat Dupuytren's contracture
- 1. Physiotherapy
- 2. Surgery
- 3. Collagenase injection
Dupuytren's contracture is a change that occurs in the palm of the hand that causes one finger to always be more bent than the others. This disease mainly affects men, from the age of 40 and the fingers most affected are the ring and pinky. Its treatment is done through physical therapy, but in some cases surgery may be necessary.
This contracture is benign but can bring discomfort and hinder the affected person's daily life, causing pain and difficulty to open the hand completely. In this case, small nodules of fibrosis are formed that can be felt when pressing on the palm region. As they grow, Dupuytren's nodules develop small strands that extend causing the contracture.
Causes of Dupuytren's contracture
This disease can be of a hereditary, autoimmune cause, it can appear due to a rheumatic process or even due to the side effect of some medication, 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 excessively seem to find it easier to develop these nodules.
Symptoms of Dupuytren's contracture
Symptoms of Dupuytren's contracture are:
- Nodules in the palm of the hand, which progress and form 'strings' in the affected area; Difficulty in opening the affected fingers; Difficulty in placing the hand properly open on a flat surface, such as a table, for example.
The diagnosis is made by the general practitioner or orthopedist, even without the need for specific tests. Most of the time the disease progresses very slowly, and in almost half of the cases both 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 anti-inflammatory resources can be used, such as laser or ultrasound, for example. In addition, joint mobilization and the breakdown of type III collagen deposits in the fascia is a fundamental part of the treatment, either through massage or with the use of devices such as the hook, using a technique called crochet. Manual therapy is capable of bringing pain relief and greater tissue flexibility, bringing greater comfort to the patient, improving his 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, surgery does not cure the disease, because it may reoccur years later. There is a 70% chance of the disease coming back when one of the following factors is present: male gender, disease onset before the age of 50, having both hands affected, having first degree relatives from northern Europe and also having the fingers affected. However, even so, surgery remains indicated because it can bring relief from symptoms for a long time.
After surgery, physiotherapy must be resumed, and a splint is usually used to keep the fingers extended for 4 months, which must be removed only for personal hygiene and to perform physical therapy. After this period, the doctor can re-evaluate, and reduce the use of this immobilization splint to 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 to the affected fascia, which also achieves good results.
Avoiding closing your hand and fingers many times a day is a recommendation to be followed, if necessary, stopping at work or changing the sector is recommended, if this is one of the causes of the appearance or worsening of the deformity.
