What is a Dupuytren Contracture?
Dupuytren Contracture is the development of a fibrous nodule on the palmar fascia of the hand that shortens and thickens the fibres leading to contractures of the ring and little fingers. It is more common amongst men and more frequently presents in the right hand, although it can affect both at once. It can be very tender and uncomfortable as it develops and ultimately leads to severe contractures that greatly limit hand functionality. Typically the fourth and fifth finger end up permanently flexed toward the palm, with strong fibrous bands preventing even passive extension.
What causes a Dupuytren Contracture?
The exact trigger for developing Dupuytren contracture is not fully understood. However, given the high incidence of hereditary cases there is likely a common genetic factor involved. This is further supported by the statistically higher numbers of cases found amongst white, northern European people.
The development of a Dupuytren contracture is divided into three phases that describe the laying down of the additional fibrous tissue. The initial proliferation phase sees myofibroblasts in the Palmar Fascia generate a fibrous nodule on the palm that can be tender when pressed. The second involutional phase sees the myofibroblasts spread along the bands of the Palmar Fascia up into the fourth and fifth digits, thickening the fibrous band into a cord. The third residual phase sees the nodule and myofibroblasts disappear, leaving a thick band of collagen that tightens causing a contracture in the fourth and fifth digit.
Above: Ongoing pain or discomfort in the hand could be a sign of hand dupuytrensWhat are the symptoms of Dupuytren Contracture?
The symptoms of Dupuytren contractures are split into grades of severity that reflect the conditions stage of development. Those grades describe the following:
- Grade 1: The slow development, sometimes over years, of a fibrous nodule in the middle of the palm, below the fourth digit. It is usually pain free and there is often a visible deformity in the skin over the nodule.
- Grade 2: The development of fibrous cords along the fascia of the fourth and / or fifth digits begins to reduce the full range of movement to extension in those fingers. As the nodule in the palm gets bigger it can cause tenosynovitis.
- Grade 3: The later stages are usually pain free, however the thickened cords of the palmar fascia contract causing pronounce contractures. This can pull the fourth and sometimes fifth digit into a position of fixed flexion, leaving you unable to straighten those fingers, even passively.
The severe contractures common to the later stages of the condition can have a pronouncedly limiting effect of your ability to perform normal tasks. Dupuytren contractures may affect both hands at the same time with onset and progression happening at different paces. The contractures can limit your ability to grip objects, and what functional movement remains may be weak.
How is Dupuytren Contracture diagnosed?
As Dupuytren contracture develops over a long period the physiotherapist or GP will need to take a detailed history of how your symptoms developed. Combined with a thorough physical examination of the hand, this will allow the examiner to effectively diagnose Dupuytren Contracture.
For more information on how physiotherapy can help a Dupuytren Contracture, please email office@liverpoolphysio.co.uk or ring us on 0151 558 0077.
How is Dupuytren Contracture diagnosed?
If you are experiencing some of the above symptoms you may have a fracture to the hook of Hamate. A doctor or physiotherapist would take a subjective history to assess the method of injury and possible damage done, before confirming their findings with a thorough physical examination of the hand. An X-ray may be requested to rule out alternate injuries and confirm the severity of the damage to the hook of Hamate.
For more information on how physiotherapy can help a fracture of hook of Hamate, please email office@liverpoolphysio.co.uk or ring us on 0151 558 0077.
What would a physiotherapy assessment for Dupuytren Contracture involve?
In your first appointment at Liverpool Physio, your assessment would be divided into the following two sections:
Subjective
A discussion to find out how long your condition has been persisting, if you have had any previous injuries in this area, what symptoms you are experiencing and how your condition is affecting you and your lifestyle.
Objective
A physical assessment of your range of pain, tenderness in the area, range of movement and a series of special tests to identify exactly which structures are likely to be affected.
What would physiotherapy treatment for Dupuytren Contracture involve?
Physiotherapy treatment for Dupuytren Contracture varies depending on the severity of the condition, but can be broadly split into two main approaches. In the early stages of the condition the physiotherapist would seek to slow the progression of any contractures developing and monitor levels of functional ability. Therapies would include:
- Heat treatments, including wax therapy, to increase tissues extensibility prior to stretches.
- Stretches, both passive and active, to maintain range of motion in the palm and fingers.
- Soft tissue massage for pain relief and to increase tissue flexibility.
- Dexterity exercises to maintain functional strength and co-ordination.
- Advice on use of customised splints during the night to maintain finger flexibility.
- Ultrasound to promote normal soft tissue healing.
If the Dupuytren Contracture develops to an advanced stage with severely limited range of movement in the fourth and fifth digits then surgical intervention will be considered. In minor cases corticosteroid injections may be used to produce rapid results. In more serious cases surgical therapy involving the excision of the diseased fascia tissue may be recommended. In either case, intense physiotherapy would immediately follow the procedure to maximise and maintain the benefits of surgical intervention.
Whatever the stage of development you are experiencing with Dupuytren contractures, the physiotherapists here at Liverpool Physio will devise a treatment plan to address your needs. Regular monitoring, advice and adaptive treatments will all help maintain the best possible functionality of the affected hand.
How can I arrange a physiotherapy assessment for Dupuytren Contracture?
If you are experiencing pain or tingling in your hand, stiffness or loss of strength and show signs of visible deformation in the skin of your palm, you may have a Dupuytren Contracture and would benefit from seeing one of our physiotherapists at Liverpool Physio.
You can contact us directly to arrange an assessment and we can advise you if further treatment is recommended, or give you details on self-management for minor cases. To arrange an appointment please email office@liverpoolphysio.co.uk or call 0151 558 0077.
Summary
Dupuytren contracture can initially be uncomfortable and ultimately lead contractures in the palmar fascia that limit hand function altogether. At Liverpool Physio we can devise a personalised treatment plan that will help maintain the best possible functionality of the affected hand, for as long as possible. Should you later need surgical intervention our experienced physiotherapists can help rehabilitate you, to maximise the benefits of having surgery.
For further information about Physiotherapy for Dupuytren Contracture, or to book yourself an appointment, please email office@liverpoolphysio.co.uk or ring us on 0151 558 0077.
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