Dupuytren Contracture: Causes, Symptoms, Treatment and Exercises

Do you have a finger that’s stuck in a bent position, and no matter what you try to do, it won’t straighten out? It could be that you have a condition called Dupuytren Contracture. Dupuytren’s can be very frustrating to live with as it makes usually simple tasks in life like putting on a glove very challenging. As such, people often find their hobbies like gardening, carpentry, or gymnastics very unenjoyable (1).

What is a Dupuytren Contracture?

A hallmark sign of Dupuytren’s is a finger that is stuck in a bent (or flexed position) (Figure 1). The inability to straighten your finger no matter what you try is called a contracture. People may also feel a lump or thick band in the palm of their hand as well, which is a sign of local overgrowth of a certain kind of tissue in the palm called collagen in a structure called the palmar fascia (Figure 1).

What Causes Dupuytren Contracture?

The etiology of Dupuytren’s is not clearly understood (1). However, common risk factors that increase your risk for developing Dupuytren’s include: diabetes mellitus, family history/genetics, alcohol, and smoking (1). Dupuytren’s is found more commonly in men than in women (1).

How can Physiotherapy, Chiropractic and/or Massage Therapy Help with Dupuytren Contracture?

Treatment for Dupuytren’s often includes surgery/injections, which will break apart the collagen overgrowth to improve extension (or finger straightening) range of motion (2). After surgery, a custom splint should be worn during the day to preserve your new finger range of motion. In addition to wearing a splint, certain exercises will need to be done to restore hand function (1). There are numerous secondary issues that arise with having your finger stuck in a bent position. For example, ligaments, tendons, and nerves surrounding the bent finger may become shortened, which further affect range of motion (1). Your physiotherapist, chiropractor and/or massage therapist will know what range of motion exercises to prescribe to you, what thermal modalities such as heat or ice should be used to manage your pain, and what strengthening exercises are appropriate to help improve your hand function.

What Should be Avoided with Dupuytren Contractures?

Generally speaking, you should limit activities that cause excessive pain as it has little therapeutic value.

How Long Does it Take to Recover from Dupuytren Contractures?

The whole process of rehabilitation for Dupuytren Contracture will take at least 3 months where you have intermittent follow-ups with your therapist and surgeon (1). Treatment can often extend beyond 3 months so that further hand function and strength can be optimized so that you can return to all your hobbies.

What are Safe Home Exercises I can do for Dupuytren Contracture?

Without surgery and rehabilitation, the chances of fixing your Dupuytren Contracture at home is very low as exercises aimed at improving your range of motion will at best likely only help you to maintain your current range of motion. Things you can do at home to maintain your range of motion include (Figure 2):

1. Making a full fist
2. Making a claw fist
3. Making a straight fist
4. Making a table top fist
5. Making a straight hand.

To manage pain, ice or heat can be applied to your hand for 15 min at a time.

If you suspect that you have a Dupuytren Contracture, consider booking a Physiotherapy, Chiropractic or Massage Therapy assessment to have your range of motion, strength and functional abilities assessed. Your therapist may be able to help your physician in his or her assessment of the severity of your condition with his or her findings, and also rule out other conditions that may present like Dupuytren Contracture. If you are diagnosed with Dupuytren Contracture, your therapist will likely refer you to your physician who may then refer you to a surgeon for further assessment. As you wait for your appointment with a specialist, your Physiotherapist, Chiropractor or Massage Therapist will likely able to help you with managing your pain, and also in optimizing your existing hand function so that you can continue to enjoy your hobbies.

References:

1. 1. Engstrand C, Liedberg GM. Evaluation of Activity Limitations and Digital Extension in Dupuytren’s Contracture Three Months after Fasciectomy and Hand Therapy Interventsions. JHT. 2009; Jan-Mar;22(1):21-6
   2. Huisstede BM, Gladdines S, Randsdorp MS, Koes BW. Effectiveness of Conservative, Surgical, and Postsurgical Interventions for Trigger Finger, Dupuytren Disease, and De Quervain Disease: A Systematic Review. Archives of Physical Medicine and Rehabilitation. 2018;99:1635-1649

 

Written by: Wesley Lai – Registered Physiotherapist