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Orthopedic diseases 2023

Dupuytren's Contracture: Symptoms, causes and treatment

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Dupuytren's Contracture: Symptoms, causes and treatment
Dupuytren's Contracture: Symptoms, causes and treatment

Dupuytren's contracture is an alteration that occurs in the palm of the hand that causes one finger to always be more bent than the others. This disease mainly affects men, from the age of 40 and the most affected fingers are the ring and pinky. Its treatment is done through physical therapy, but in some cases surgery may be necessary.

This contracture is benign but can cause discomfort and make the affected person's daily life difficult, causing pain and difficulty in fully opening the hand. In this case, small nodules of fibrosis are formed that can be felt when pressing the region of the palm of the hand. As they enlarge, Dupuytren's nodes develop small cords that stretch causing contracture.

Causes of Dupuytren's Contracture

This disease can be hereditary, autoimmune, can appear due to a rheumatic process or even due to the side effect of some medication, such as Gadernal. It is usually caused by the repetitive motion of closing the hand and fingers, especially when vibration is involved. People who have diabetes, smoke and consume alcohol in excess seem to have an easier time developing these nodules.

Symptoms of Dupuytren's Contracture

Symptoms of Dupuytren's Contracture are:

  • Nodules on the palm, which progress and form 'ropes' in the affected area;
  • Difficulty opening affected fingers;
  • Difficulty placing the hand properly open on a flat surface, such as a table, for example.

The diagnosis is made by the general practitioner or orthopedist, even without the need for specific exams. Most of the time the disease progresses very slowly, and in almost half of the cases both hands are affected at the same time.

How to treat Dupuytren's contracture

The treatment can be done with:

1. Physiotherapy

Treatment for Dupuytren's contracture is performed with physical therapy, where anti-inflammatory resources such as laser or ultrasound can be used, for example. In addition, joint mobilization and the breakdown of type III collagen deposits in the fascia are a fundamental part of the treatment, either through massage or with the use of devices, such as the hook, using a technique called crocheting. Manual therapy is capable of bringing pain relief and greater tissue malleability, bringing greater comfort to the patient, improving their quality of life.

2. Surgery

Surgery is particularly indicated when the contracture is greater than 30º in the fingers and greater than 15º in the palm of the hand, or when the nodules cause pain. In some cases, surgery does not cure the disease, because it can recur years later. There is a 70% chance of the disease returning when one of the following factors is present: male gender, onset of disease before age 50, having both hands affected, having 1st degree relatives from northern Europe, and having affected fingers as well. However, even so, surgery is still indicated because it can bring relief from symptoms for a long time.

After the surgery, physiotherapy is required again, and a splint is usually used to keep the fingers extended for 4 months, which should be removed only for personal hygiene and to perform physiotherapy. After this period, the doctor can re-evaluate, and reduce the use of this immobilization splint to use only during sleep, for another 4 months.

3. Collagenase injection

Another, less common form of treatment is the application of an enzyme called collagenase, derived from the bacterium Clostridium histolyticum, directly on the affected fascia, which also achieves good results.

Avoid closing the hand and fingers too many times a day is a recommendation to be followed, if necessary, a stop at work or change of sector is recommended, if this is one of the causes of the appearance or worsening of the deformity.

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