Physical Therapy, Pain Management, Hand and Wrist
Dupuytren’s disease is a condition described as an overgrowth of collagen in the fascia, the thin layer of connective tissue under the skin. Collagen is a naturally occurring protein in the body that supports bones and connective tissues and provides elasticity for the skin. One-third of the body’s protein is thought to be some type of collagen.
When the condition first appears, symptoms are noticeable but do not cause pain. Small bumps or nodules may appear on the palm close to the base of the ring and small fingers. While the area around the nodules may be tender, the symptoms do not cause widespread hand pain.
As collagen in the affected area continues to overgrow, the fascia shortens, and the skin appears dimpled where the fourth and fifth fingers connect to the palm. In the active and advanced phases, the overproduction of collagen creates cords that extend to the fingers, pulling or contracting them toward the palm. This most advanced condition is known as Dupuytren’s Contracture.
In advanced stages, the condition limits life’s daily movements. People cannot flatten their hands, wear gloves, pick things up, or wash their hands properly.
The condition gained its name from Napoleon’s surgeon, Guillaume Dupuytren, who did not suffer from or discover the disease but gave a lecture about the condition at the height of his fame.
Many think the condition is hereditary. One out of four people who have symptoms has a relative who has the disease. Other records show Dupuytren’s Contracture often affects men of Scandinavian descent. For that reason, it also is known as Viking’s Disease. Other risk factors of Dupuytren’s Contracture include:
If you notice symptoms in your hands, contact your medical provider. Dupuytren’s disease is diagnosed through a physical exam, medical history, and a lifestyle assessment.
Unfortunately, there is no cure. The goal of treatment is to restore movement and function.
In the early stages, providers may prescribe medication, exercises, or physical therapy to relieve symptoms and maintain the range of motion.
If the condition impairs movement, providers may recommend clostridial collagenase injections. This two-step, two-day treatment may improve hand function. On the first day, the provider injects medication into the affected area to destroy or break-up the excess collagen. On the second day, the patient returns to the provider’s office for aggressive hand stretching. Patients receive local anesthesia to prevent discomfort during both days of the procedure.
Needle aponeurotomy is a minimally invasive procedure performed in the office under local anesthesia. The procedure uses a needle to break-up and sever the cords causing the contracture. This may be a treatment option for some people.
Surgery is not recommended for mild cases. It seems to stimulate collagen growth and carries the risk of damage to neurovascular structures, which change because of the contraction.
After contracture sets in, a surgery called fasciectomy removes abnormal tissues and restrictive cords to restore some movement and relieve pain. Sometimes, a skin graft is required. Recovery may be long and require physical therapy to regain maximum function.
Even with surgery, Dupuytren’s Contracture comes back 50 percent of the time.
Some people find hand massage and exercises keep the hand flexible and prolong function. But these proactive actions may not stop the disease from progressing.
People with early-onset Dupuytren’s should avoid curling the hand as much as possible. Using utensils and tools with larger handles may help and may make daily living activities more comfortable.
If you notice bumps or nodules on the palms of your hands, make an appointment with an orthopedic hand specialist. Early detection may give you more treatment options.
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