Dupuytren’s Contracture: Diagnosis, Treatment, and Rehabilitation at Palms Physiotherapy & Allied Health

What is Dupuytren’s Contracture?

Dupuytren’s contracture is a progressive condition where the fascia, the connective tissue beneath the skin, thickens and forms cord-like structures. These cords pull the fingers inward toward the palm, limiting the ability to straighten the fingers. In more severe cases, the affected fingers may become permanently bent. Although Dupuytren’s contracture is not typically painful, the loss of finger movement can affect daily activities, such as shaking hands, holding objects, or performing fine motor tasks.

The condition usually develops slowly over many years and is more common in people aged over 50, particularly those of Northern European descent. It is often associated with a family history of the condition and may also occur alongside other conditions, such as diabetes or epilepsy.

Symptoms of Dupuytren’s Contracture

The progression of Dupuytren’s contracture occurs in stages, and symptoms can vary from person to person. The following signs and symptoms may indicate the development of the condition:

1. Lumps or Nodules in the Palm

• Small lumps or nodules may form in the palm, often in the area near the base of the fingers. These lumps are usually firm and may not be painful, but they are indicative of thickening tissue.

2. Tightening of the Skin

• As the condition progresses, the skin of the palm may become tight and dimpled, often causing discomfort due to restricted movement.

3. Finger Curling

• Over time, the cords formed in the palm pull the fingers inward, leading to the inability to fully straighten the affected fingers.

• The ring and little fingers are most commonly affected, though the middle and index fingers can also be involved.

4. Loss of Hand Function

• Difficulty with gripping or holding objects, as well as performing tasks that require fine motor skills, such as typing, buttoning clothes, or using utensils.

5. Pain (in severe cases)

• While Dupuytren’s contracture is not typically painful, in some cases, the condition may become uncomfortable or painful due to the tension in the tendons and fascia.

Causes of Dupuytren’s Contracture

The exact cause of Dupuytren’s contracture is not fully understood, but several factors are believed to contribute to its development:

1. Genetic Factors

• A family history of Dupuytren’s contracture significantly increases the likelihood of developing the condition. It is considered a genetically inherited disorder, often running in families.

2. Age and Gender

• The condition is more common in men, particularly those over the age of 50, although it can occur at any age.

3. Ethnicity

• People of Northern European descent are more likely to develop Dupuytren’s contracture, with the condition being much rarer in other ethnic groups.

4. Medical Conditions

• Diabetes: People with diabetes are at an increased risk of developing Dupuytren’s contracture, though the exact link between the two is not fully understood.

• Epilepsy: Individuals with a history of epilepsy, particularly those who use anti-seizure medications, may have an increased risk.

5. Smoking and Alcohol Use

• Heavy drinking and smoking are believed to contribute to the development of Dupuytren’s contracture, likely due to their negative effects on circulation and connective tissue health.

Diagnosis of Dupuytren’s Contracture

Dupuytren’s contracture is typically diagnosed through a physical examination by a healthcare professional. Your physiotherapist or doctor will assess the condition by looking for signs such as lumps or nodules in the palm, and testing the movement of the fingers to determine the extent of the contracture.

1. Clinical Examination

• The healthcare provider will examine the palm and fingers for any lumps or thickening of the tissue and may ask the patient to try and straighten the fingers to assess the degree of flexion contracture.

2. Medical History

• A thorough medical history will be taken to check for any family history of Dupuytren’s contracture, as well as any associated conditions, such as diabetes or epilepsy.

3. Ultrasound or MRI

• While rarely required, in some cases, an ultrasound or MRI may be used to assess the extent of tissue thickening or to rule out other causes of hand dysfunction.

Treatment Options for Dupuytren’s Contracture at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, we offer a multidisciplinary approach to the treatment of Dupuytren’s contracture, aiming to manage symptoms and improve hand function through a combination of non-invasive and, if necessary, surgical options.

1. Physiotherapy and Stretching

• Physiotherapy plays a crucial role in managing Dupuytren’s contracture. Our physiotherapists can help maintain finger mobility and prevent further tightening through specialized stretching exercises, joint mobilizations, and manual therapy techniques.

• Regular hand exercises can improve flexibility and prevent the condition from worsening.

2. Splinting

• In some cases, splints or orthoses may be used to help maintain hand function, especially at night, to prevent further finger contractures.

3. Needle Aponeurotomy (NA)

• A minimally invasive procedure in which a needle is used to puncture the cords of the fascia, breaking them down to release tension and allow the fingers to straighten.

4. Enzyme Injections

• Collagenase injections may be used to break down the thickened tissue that causes the contracture. This approach can be effective in some cases and may delay the need for surgery.

5. Surgery

• In more severe cases, surgery may be recommended to remove the affected tissue or release the contractures. Common surgical procedures include:

  • Fasciectomy: Removal of the thickened tissue.

  • Needle aponeurotomy or open surgery may be performed for more advanced contractures that do not respond to other treatments.

6. Post-Surgery Rehabilitation

• If surgery is required, post-surgical rehabilitation will be crucial to help restore hand function, prevent recurrence, and improve overall mobility.

Recovery and Rehabilitation

Recovery from Dupuytren’s contracture treatment depends on the severity of the condition and the type of intervention used. Post-treatment rehabilitation typically includes:

• Stretching and Strengthening Exercises: These exercises help restore hand function and prevent contracture recurrence.

• Massage: Scar tissue massage may be recommended to promote healing and reduce tension in the affected area.

• Gradual Return to Activities: It’s important to gradually return to tasks that require hand strength and dexterity to avoid re-injury or worsening of the condition.

Conclusion

While Dupuytren’s contracture can significantly impact hand function, early diagnosis and treatment can help manage symptoms, improve mobility, and prevent further progression of the condition. At Palms Physiotherapy & Allied Health, our expert team provides a comprehensive treatment approach to help you regain hand function and improve your quality of life.

If you’re experiencing symptoms of Dupuytren’s contracture or need help managing your condition, contact us today for an assessment and personalized treatment plan.

For more information or to book an appointment, visit our Malaga, Noranda, or Ellenbrook clinics, or use the booking links below.