HAND/WRIST
So you just left the doctor’s office and the physician told you that your hands have some kind of disease that you have never even heard of never-mind even pronounce. All you heard was the second part...disease. You are wondering....how? Why?? What is it?? What was that word he said? You have so many questions and when you get home you see the diagnosis as Dupuytrens Disease... pronounced as "du- pa- trens". As a therapist, I found this to be the common reaction that people have told me when they first heard their diagnosis of Dupuytrens. I decided to write my blog this week to hopefully give some insight that may clear up some of these questions.
So what exactly is Dupuytrens Disease? First I’d like to explain to you a few things. Throughout our entire body we have fascia. Fascia is an intricate system of the body that has the appearance similar to a spider's web or ladies nylons. I often ask patients if they recall when they have ever cut up chicken and you can peel back a thin white layer. This is fascia. It is very densely woven, and it covers and interpenetrates every muscle, bone, nerve, artery and vein, as well as all of our internal organs. Now that you have some understanding of the fascia, I can explain to you about Dupuytren’s. In individuals diagnosed with Dupuytren’s, the fascia in their hand or hands slowly begins to thicken and starts to cause noticeable changes in the palm. Initially for some, slight puckering or dimpling of the skin due to fascial changes under the skin. As this progresses, a cord begins to become evident where the nodule was. Often, some patients come in thinking that they have some sort of tendon injury in the hand or digit. The cords contain collagen and progressively tighten. As the cords tighten, they progressively begin to flex (bend) the digit or digits down towards the palm. At this point, individuals begin to have functional limitations. The biggest complaints that we hear are that they can no longer hold objects, put their hands in their pockets, shake hands or perform leisure activities such as tennis or golf. Most oftenly, it occurs in the ring and small fingers but are not limited to these digits.
So who gets Dupuytren's disease? Dupuytren's occurs more often in men than women. It most commonly will affect individuals between the ages of 50 and 60, however not limited to those ages. According to the International Dupuytren's Society, there have actually been some cases of it occurring in children, although it is fairly rare. Dupuytren's is considered to be an inherited, genetic disorder. It is known to predominantly affect those of northern European descent. It was initially thought to have traced back to the early Viking days and also can be known as "Viking hand". According to the British Dupuytren 's Society , archaeologists diagnosed Dupuytren's in the hand of an Egyptian mummy. Another finding found from a cave painting found the print of a hand with possibly having a Dupuytren's contracture with a cord going to the ring and middle fingers. So the next time someone asks you why you have Dupuytren's, you can tell them all about your possible Viking ancestors! There are a few factors that can potentially increase your risk for developing the disease. These include a family history, diabetes, smoking and increased alcohol consumption.
Is there any treatment for the disease? Currently, there is no cure for the disease however research continues and treatments have progressed over the years. Treatment can be dependent on one's health, severity of the disease and the impact that it is having on an individual's activities of daily living. An assessment by a hand surgeon can determine if non-surgical or surgical intervention is best. As contractures progressively get worse, it can be more complex surgically and rehabilitation afterwards can become much more involved and lengthy. Rehabilitation afterwards typically entails custom splinting (for up to 6 months- initially full time and transitioning to night use), wound care, extensive scar management, range of motion, functional retraining and strengthening exercises.
In the early stages, some physicians may attempt or recommend steroid injections or a procedure called needle aponeurotomy. With needle aponeurotomy , the surgeon takes a needle to the cord area, divides and cuts the diseased tissue in the palm and digit involved. In my clinical experience, I have rarely seen patients with Dupuytrens to have had the steroid injections or needle procedures. In the past several years, we are seeing patients undergo a procedure called Xiaflex injections. This has been a huge alternative to surgery . If a surgeon finds that an individual is a good candidate, they undergo the procedure right in the doctor's office. The hand surgeon injects the cord with the Xiaflex (which is a mixture of enzymes) into the cord. In 24-48 hours, the surgeon sees the patient back in the office and numbs the area. The surgeon then manipulates the digit and releases the contracture. How does this happen? Essentially, the medication unravels, breaks up and loosens up the diseased tissue. Following the procedure, rehabilitation is typically very short. The patient wears a custom night splint. Some individuals require working on range of motion and edema management. Typically, rehabilitation after varies from one day to two - three weeks.
The goal of my blog was to hopefully encourage individuals to consult with a surgeon sooner than later. Be proactive! Don't wait until you ca not functionally move your hand or perform the activities that you love! If you begin to not be able to place your hand flat on a surface, I would strongly encourage you to consult with a hand surgeon. Remember the longer you wait, the more challenging it may be to treat.
