Chiropractor Chandler AZ
Dupuytren's contracture is a fibrosing disorder which, slowly and over time, results in a thickening of the fibrous tissue underneath the skin of the palm and fingers. This disease is painless, but the thickening and contracture of the fibrous tissue causes the little and ring fingers to flex or curl. Firm bumps or cords form from the fibrous tissue and can be felt when the fingers are flexed. When the fingers begin to flex, it becomes harder, and sometimes painful, to straighten them out again. Dupuytren's contracture can make doing the simplest, everyday tasks very difficult, like putting your hand in your pocket.
Although the cause of Dupuytren's contracture is unknown, there are factors which put people at greater risk for developing the disease. It is most common in people of Northern European descent; it is often hereditary; it is possibly related to consumption of alcohol; it is associated with medical conditions such as diabetes and seizures; it increases in frequency with age; and is more common in men. There is no evidence that suggests Dupuytren's contracture is related to hand injury or heavy use. Even with slow development and progression of the condition, more severe and disabling cases do occur, especially with old, stubborn men who ignore the symptoms. I can confidently say this thanks to my family's predominance of stubborn Northern European men who ignore all things related to health.
The pictures included here are ofa family member who waited more than 15 years before seeking medical treatment. Needless to say, surgery was necessary. He simply waited too long before seeing treatment, which limited his functional gains and improvement. And the truth is he would have waited longer, but his other hand progressed to the point that he could not get his keys or wallet out of his pockets. Inability to use either hand was the "final motivation" required for him to seek treatment (on one hand only because he didn't think he needed surgery on both).
Dupuytren's contracture usually begins as a thickening of the skin of the palms and fingers, normally the 4th and 5th digits. Dimples may appear on the palm as the thickening continues. Eventually, a firm lump can be found on either the palm or fingers. Although no pain is felt from the lump, it can be sensitive to touch. In later stages of the condition, cords of scar tissue form under the skin on the palm and can extend all the way up to the fingertips. When these cords flex, it is what causes the fingers to bend toward the palm. In severe cases, the fingers can be bent to where they touch the palm.
In some instances the decreased hand tissue flexibility and movement leads to nerve compression or entrapments. Several important nerves control hand and finger muscle and sensations, including the median, radial, and ulnar nerve. In people who have dealt with the contracture for years, the ulnar nerve compression motivates people to seek treatment or surgery.Treatments for Hand Contractures
Decreasing the inflammation or irritation of the scar tissue is the priority of the treatment. Swelling is low during the early stages of the disease and doesn't affect day-to-day life like more severe cases. In those severe cases, it may become painful to fully extend the fingers. Treatments to help reduce inflammation and curb the pain include rotating between heat and ice, electrotherapy, or ultrasound therapy. Stretching exercises of the fingers can help reduce the scar tissue between the soft tissue and can be very painful, but is extremely necessary. Another treatment option is needling. Needles are inserted through the skin to puncture and break the cord of tissue contracting the finger. This is a minimally invasive technique and can be done on multiple fingers at one time, but there is a high risk of nerve damage.
The Graston Technique is a very effective treatment for breaking down the fibrous tissue cords contracting the fingers. This treatment uses specifically designed stainless steel instruments and therapeutic exercises to detect and treat areas of swelling and inflammation. The instruments slide along the skin and help one layer of tissue slide past another. The force of the sliding motion breaks up the scar tissue while simultaneously triggering the body's healing process to start regenerating new tissue. The Graston Technique decreases recovery time and reduces the need for anti-inflammatory medication. However, more severe cases of Dupuytren's may require surgery, in which case the Graston Technique can be utilized after the surgery to break up any lingering scar tissue.
Cold laser therapy is a noninvasive procedure, meaning no surgery is required. It is also often used to treat tendon injuries. Class IV K cold lasers use infrared lasers to help decrease the inflammation of the fibrous tissue, reduce pain to provide relief, and enhance tissue healing/regeneration. Injured cells within the scar tissue are targeted because they are more readily accepting of the photons of light that the lasers give off. This triggers increased adenosine triphosphate production within the soft tissues of the hand, which allows the cell to spend more energy for repair and healing. Cold laser therapy is often compared to photosynthesis because the tissue absorbs the light and converts it to useable energy, which aids the healing process and provides relief for knee pain.
In the most severe cases of Dupuytren's Contracture, surgery is required. It is a very complex surgical procedure dealing with a lot of built-up hand tendon scar tissue. Surgery comes with risks of injuring nerves and blood vessels. Although rare, there is also a chance of permanent stiffness in the fingers following surgery. To avoid surgery, contact our Chandler Chiropractic & Physical Therapy office for more information on non-surgical treatments for Dupuytren's.