Diagnosis
In most cases, doctors can
diagnose Dupuytren's contracture by the look and feel of your hands. Other
tests are rarely necessary.
Your doctor will compare
your hands to each other and check for puckering on the skin of your palms. He
or she will also press on parts of your hands and fingers to check for
toughened knots or bands of tissue.
Your doctor also might check
to see if you can put your hand flat on a tabletop or other flat surface. Not
being able to fully flatten your fingers indicates you have Dupuytren's
contracture.
Treatment
If the disease progresses
slowly, causes no pain and has little impact on your ability to use your hands
for everyday tasks, you might not need treatment. Instead, you can wait and see
if Dupuytren's contracture progresses. You may wish to follow the progression
with a tabletop test, which you can do on your own.
Treatment involves removing
or breaking apart the cords that are pulling your fingers toward your palm.
This can be done in several ways. The choice of procedure depends on the
severity of your symptoms and other health problems you may have.
Needling
This technique uses a
needle, inserted through your skin, to puncture and break the cord of tissue
that's contracting a finger. Contractures often recur but the procedure can be
repeated.
The main advantages of the
needling technique are that there is no incision, it can be done on several
fingers at the same time, and usually very little physical therapy is needed
afterward. The main disadvantage is that it can't be used in some places in the
finger because it could damage a nerve or tendon.
Enzyme injections
Injecting a type of enzyme
into the taut cord in your palm can soften and weaken it — allowing your doctor
to later manipulate your hand in an attempt to break the cord and straighten
your fingers. The FDA has approved collagenase Clostridium histolyticum
(Xiaflex) for this purpose. The advantages and disadvantages of the enzyme
injection are similar to needling. Enzyme injections are not offered at all
medical institutions.
Surgery
Another option for people
with advanced disease, limited function and progressing disease is to
surgically remove the tissue in your palm affected by the disease. The main
advantage to surgery is that it results in a more complete and longer-lasting
release than that provided by the needle or enzyme methods. The main
disadvantages are that physical therapy is usually needed after surgery, and
recovery can take longer.
In some severe cases,
especially if surgery has failed to correct the problem, surgeons remove all
the tissue likely to be affected by Dupuytren's contracture, including the
attached skin. In these cases a skin graft is needed to cover the open wound.
This surgery is the most invasive option and has the longest recovery time.
People usually require months of intensive physical therapy afterward.
Lifestyle and home remedies
If you have mild Dupuytren's
contracture, you can protect your hands by:
Avoiding a tight grip on
tools by building up the handles with pipe insulation or cushion tape
Using gloves with heavy
padding during heavy grasping tasks
However, your condition may
persist or worsen, despite these precautions.
Preparing for your
appointment
While you might first bring
your symptoms to the attention of your family doctor, he or she might refer you
to an orthopedic surgeon.
What you can do
Before your appointment, you
might want to write a list that answers the following questions:
Do you have a family history
of this problem?
What treatments have you
tried? Did they help?
What medications and
supplements do you take regularly?
What to expect from your
doctor?
Your doctor might ask some
of the following questions:
When did your symptoms
begin?
Have they been getting
worse?
Is your hand painful?
How does the contracture
interfere with your day-to-day tasks?
Jan Ricks Jennings, MHA,
LFACHE
Senior Consultant
Senior Management
Resources, LLC
JanJenningsBlog.Blogspot.com
412.913.0636 Cell
724.733.0509 Office
January 8, 2022
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