Jordan Smith, one of our physio team at Blackberry Clinic Milton Keynes and also at Blackberry Clinic Oxford writes about a difficult and often distressing disease causing the middle and ring fingers of the hand to contract, making using the hand properly very difficult. There are treatments for this problem and at Blackberry Clinic we offer physiotherapy treatments and steroid injections as well as musculoskeletal ultrasound examination to confirm diagnosis.
Dupuytren’s contracture is a benign progressive disease of the palmar fascia which results in shortening, thickening and fibrosis of the fascia and aponeurosis. This disease primarily affects the hand and fingers resulting in a contracture deformity. The most commonly affected digits are the middle and ring fingers.
The disease begins in the palm as painless hard nodules that form longitudinal lines of tension. The nodules form cords that produce contracture deformities within fascial bands and tissues of the hand. This condition is usually bilateral with the right side being most commonly affected. Middle aged white males are most affected and a family history increases chances of onset.
In 50-70% of cases, stagnation or even regression of presentation will occur. Onset is generally gradual over several years but can be as fast as a few months/weeks.
Dupuytren’s Contracture is usually very obvious and easily diagnosed without further investigation. However, if clarity is required:
- X-rays of the hand should be obtained to examine for other contributing, bony abnormalities that may contribute to the loss of range of motion.
- Laboratory workup such as blood tests to rule out diabetes is recommended.
- Diagnostic ultrasound may demonstrate thickened palmar fascia and the nodules.
Conservative management such as physiotherapy aims to maintain or improvement range of motion in the hand via passive and active treatment methods. This is often performed in conjunction to splints (in particular at night) and progressing the extension range these splints place the digits into. In severe cases surgical intervention may be required. Post-operative care involves early intervention to restore full range of motion and strength in the hand to ensure optimal function and reduce the likelihood of future onset.
Medical management
- Corticosteroid injections can help reduce pain
- Collagenase injections
- Surgical fasciectomy
If you are concerned that you may be developing Dupuytren’s Contracture, do not panic and worry as this is a very common condition. Early recognition ensures longevity of hand function and reduced pain as well as decreasing the need for surgical intervention further down the line. Seeking advice from medical and healthcare professionals is the best first step in tackling this condition. They will ensure the most appropriate treatment interventions and individualised rehabilitation plans are discussed.
If you have any concerns about this or other musculoskeletal conditions we have an expert team of musculoskeletal medicine doctors and physiotherapists, osteopaths and chiropractors to help you.
