The bones that make up the hand and the wrist provide the body with support and flexibility in order to manipulate objects in many different ways. With the support of the ulna and radius of the forearm that support many of the hand’s muscles, the 27 bones in the hand have an incredibly precise range of motion. The hand can be considered in four segments:
- Fingers – digits that extend from the palm of the hand, making it possible to grab the smallest of objects
- Palm – the “high-five” side of the hand
- Dorsum – the back side of the hand where a web of veins is often visible
- Wrist – the point of connection between the hand and the forearm which facilitates proper motion of the hand
These four segments, along with a network of muscles, tendons, and tissues work cohesively to enable the hand to perform the most complicated activities. Unfortunately, like the rest of the body, hands and wrists are susceptible to number of different injuries and conditions.
Dupuytren’s contracture is a hand deformity that develops gradually, over the years. This condition occurs as result of the thickening and tightening of the fibrous layers of tissues under the skin of the palm of the hand and fingers. There is no associated pain with the thickening process, but it can cause the finger to curl inwards. Dupuytren’s contracture occurs more frequently in men than woman and is typically hereditary and may be linked to certain medical conditions such as diabetes and seizures.
Signs and symptoms of Dupuytren’s contracture include:
- Presence of one or more small, tender lumps or nodules in the palm
- Thick bands of tissues under the skin of the palm
- One of more fingers bending towards the palm of the hand, typically the ring and little fingers, making it difficult to grasp large object
Diagnosis of Dupuytren’s contracture is generally made entirely upon a physical examination. The physician will closely examine the hands and compare them to each other, checking for abnormalities. They may apply pressure on different parts of the hands and fingers to identify any tough knots or bands of tissues. The physician will make a note of the location of the nodules and thick bands, measuring for the amount of contracture within the fingers and use these measurements throughout the treatment to study the progression of the disease.
Unfortunately, there is no way to stop Dupuytren’s contracture, nor is there a way to entirely cure it. However, due to the slow progression of the disease, it typically does not cause much trouble for years, and often it does not progress beyond the formation of nodules in the palm. If the lumps in the palm or the bending of the fingers are painful or interfering with day-to-day activities, there are a few treatment options.
Splint – The physician might recommend the use of a supportive splint to reduce discomfort, however, splinting will not prevent further bend in the finger, and in some cases may speed the progression of the contracture.
Steroid Injections – Injecting the painful lump with cortisone, a powerful anti-inflammatory medicine, might aide in relieving pain for several months, in some cases may prevent progression of the contracture, but might require several injections for a lasting effect.
Enzyme injections – Injecting the painful lump with an enzyme can soften and weaken it, allowing the physician to manipulate the hand in an attempt to straighten the fingers by breaking the tough cord.
Needling – Using a needle, the physician can puncture the tough cord of issue that is causing the contracture in an attempt to straighten the fingers.
Surgery – Surgery may be an option when the physician confirms that the disease is progressing through routine measurement of the nodules and the thick bands. The goal of surgery is to divide or remove the thickened bands in order to restore motion of the fingers. Options must be discussed extensively with the physician to identify the appropriate surgical procedure.
Recovery after surgery depends on the severity of the contracture and the complexity of the procedure. Specific exercises prescribed by a physical therapist may be helpful in strengthening the hands and movement in the fingers. There will be some swelling and soreness, but elevating the hand above heart level and gently moving the fingers will assist in reducing pain and stiffness in the fingers.
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