What are the treatment options for Dupuytren’s contracture?
D
upuytren’s contracture is a condition of the hand where fibrotic tissue accumulates that causes a retraction of the flexor tendons and therefore the fingers are flexed. Guillaume Dupuytren (1831) was the doctor who described its pathological anatomy, clinical course and possible aetiology, in addition to proposing a treatment. It is retractable sclerosis of the palmar fascia, this flexion contracture generates disability due to the loss of the basic functions of the hand. It is more frequent in men, especially manual workers and usually has a family inheritance although little is known about its real causes. It affects more the ring and little fingers and more rarely the thumb. In 40%-65% of patients, the disorder is bilateral (in both hands).
Signs and symptoms of Dupuytren’s contracture
One or both hands may be affected, the ring finger is affected more frequently, followed by the little finger, the middle finger and the index finger. A small, painless lump develops in the tissue under the skin on the palm side of the hand. Over time, it thickens and forms a cord-like band. It becomes difficult to extend or straighten the fingers. In severe cases, stretching them is impossible, therefore the only solution is a surgery called Fasciectomy.
Dupuytren’s contracture surgery
Any Several experts agree that partial fasciectomy is the only valid treatment for Dupuytren´s contracture, which refers to excision of diseased and thickened fascial tissue, generally in longitudinal and zig-zag incisions (in the case of multiple compromised fingers). Complete fasciectomies involve removing the entire palmar fascia, it is indicated in advanced contractures. Post-operative rigidity is frequent due to hematoma and oedema, therefore early passive mobilizations are indicated.
Treatment of Dupuytren’s contracture
Physiotherapy is the best way to go in a post-operative Dupuytren’s contracture since effective results have not been shown with conservative treatment. There is no proven effective non-surgical treatment method, such as vitamin E intake, and local steroid injection, electrotherapy, in addition to ultrasound, they are not beneficial.
Application of stretches of the contracted “cord” have not shown good results. Some experts propose the continuous extension technique by placing a tutor or external fixator, which exerts passive traction on the finger and which was initially used in isolation but it is currently used as a pre-surgery treatment for severe digital retractions.
The post-operative physiotherapeutic objectives for Dupuytren’s disease
1. Minimize the effects of oedema and healing adhesions.
2. Maintain the extension of the interphalangeal and metacarpo-phalangeal joints achieved in surgery.
3. Recover the flexion of the fingers.
4. Recover the strength and resistance of the hand (Intrinsic and extrinsic muscles).
5. Active and passive exercise program to maintain hand mobility.
6. Exercise program with specific functions of the hand (gripper, grip, opposition, and others ..)
The rehabilitation and physiotherapy program must be applied after all hand surgery, including this pathology. Failure to attend physiotherapy and rehabilitation sessions results in failure of the surgery and the inadequate restoration of functions.
