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How To Treat Dupuytren's Contracture

October 17, 2020

If a person suffers from dupuytren's contractures that means that their affected fingers can't be straightened all the way out like most people's. This is a hand deformity that is more common in males and usually develops later on in life. It affects the layer of tissue right under the skin of their palm. Knots will end up forming and create a cord which causes the affected person's hand to bend. 

This condition makes it difficult to do normal daily activities such as tying a shoelace or holding eating utensils. Simply pulling out a credit card to pay for groceries can become too difficult for a patient suffering from dupuytren's contracture.  

When a patient's dupuytren's contracture starts to act up, it is generally the two fingers farthest from the thumb that are affected. While they are still able to pinch objects with their thumb and pointer finger, moving the others is something they can't do when this condition is acting up.

Luckily, most patients have reported that they don't experience pain from dupuytren's contracture. Those who do experience pain usually do because of another pre-existing hand condition, such as arthritis. A small percentage of patients do experienceitching in the affected area.  

Unfortunatley there isn't a cure yet for this hand condition. However, there are many forms of dupuytren's contracture treatment options available. These treatments can ease any suffering the patient is experiencing and help them get back to living normally. 

Dupuytren's Contracture Treatment Options

Most doctors will be able to tell right away if a patient is suffering from dupuytren's contracture just by feeling their hand and comparing it to the hand that isn't affected. They will examine your hand for any puckering of the skin and press on your hands and fingers to feel for knots. 

If that doesn't tell them everything they need to know they can try other methods, such as testing to see if the patient can lay their hand out flat on a counter top.  They may also get them to perform pinch and grip tests to see what the patient is capable of doing.

The doctor should measure and record the locations of nodules and bands on the affected patient's palm. They should also measure how much their fingers can curl and contract, as well as the range of motion in their fingers. This information will then be used to compare to later measurements to see how treatment for the condition is working. 

For patients that are affected by dupuytren's contracture there are a few different options available for treatment. For some patients, the condition causes them very little pain. They are able to continue with the tabletop test to help the progression. 

In order to successfully treat a patient's hand, the cords that are pulling the fingers towards the palm need to be broken or removed. If a patient's condition is too severe to be controlled with the tabletop method, then they will need to seek other options for treatment. 

Needling

In this technique, the doctor uses a needle to puncture and then break the cord of tissue that's pulling the finger towards the palm. Although the dupuytren's contracture may come back, this procedure can be repeated as needed. 

The best part about the needling technique is that it doesn't require an incision. The doctor can perform this on several fingers at one time. The only downside is that the doctor has to be very careful where they put the needle, as it could damage a nerve or tendon if the wrong spot is hit.

Surgery

For patients with severe dupuytren's contracture condition, surgery is the most common form of treatment. In this case the surgeon will remove the affected tissue from your hand. This treatment has a longer-lasting relief than what needling provides. 

The disadvantage to having surgery to treat dupuytren's contracture is that the patient usually needs physical therapy afterwards. For some patients it takes months to get back to normal. Surgery is more invasive and has a muchlonger recovery time than other treatment options.

Enzyme Injections

Surgery might be too intense for some patients, so enzyme injections are their next best bet. This process is done by injecting an enzyme into the patient's taut cord in their palm in order to soften and weaken it. This numbs the affected area allowing the doctor tostraighten the patient's fingers by breaking the cord.

TheFDA approved the use of collagenase Clostridium histolyticum for enzyme injections. Patients shouldn't have anything to worry about when seeing their doctor for an enzyme injections. The main downfall to this treatment is that it's release doesn't last as long as the surgery.

Radiation Therapy

Radiation therapy is a less common practice for treating dupuytren's contracture. It is most effective if the condition is caught in the early stages. This process is done by focusing low-energy x-rays at the nodules. If caught early enough, it could soften the nodules and help to prevent future contractions.

It has been shown todecrease progression of dupuytren's contracture and reduce symptoms. Although this practice is done more in the UK, doctors in the US are starting to see it's benefits.

Steroid Shot

Depending how painful a patient's condition is a doctor may recommend giving them a steroid shot to ease the symptoms. This may prevent the dupuytren's contracture from getting worse over time. In order for the effects to last the patient may be required to get repeated injections. 

How To Treat Dupuytren's Contracture: Final Thoughts

The severity of a patient's condition should be what determines their choice of treatment. If a patient is fortunate enough to catch dupuytren's contracture early enough they may be able to reduce the symptoms without seeking further treatment.  

To avoid worsening your condition after treatment make sure all the grips on your tools have a nice cushion and never grasp them tightly. You should also avoid wearing any gloves with heavy padding when you are doing work. 

 


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