Dupuytren's Contracture

Question 1

Contracture or thickening of palmar fascia, resulting in a flexion deformity

Answer 1

Dupuytren’s Contracture

Question 2

• Age/Gender: Men > Women (men after 30, women after 45)
• Family History
• Alcoholism
• Liver disorders
• Diabetes
• Epilepsy

Answer 2

Risk Factors for Dupuytren’s Contracture

Question 3

• Inability to extend affected digits voluntarily or by force
• Initially, tenderness over fascia, small dimple distal to crease – visible when fingers extended but disappear with flexion or relaxation of palm
• Nodule appears near distal palmar crease
• Often bilateral
• MCP & IP jts of 4th and 5th most frequently affected
• ↓ in circulation occurs d/t denseness of tissue – temp is lower by 3 - 5º C – coolness in hands d/t ischemia
• Tendons appear thick/raised, skin becomes rigid over top
• TP’s in PL refer into palm – prickly pain experienced
• ↑ tone in forearm/wrist flexors, intrinsics of hand, RC, cervical mm, lats, serratus anterior
• May see Hyperkyphosis or TOS as contributing factors
• 5% plantar aponeurosis also affected

Answer 3

Clinical Manifestations of DC`

Question 4

• Postural analysis
• Rule out: elbow
• Active: wrist, fingers - client unable to actively extend wrist or fingers
• Passive: wrist, fingers - ↓ extension, leathery end-feel, may be pain
• Resisted: wrist, fingers - ↓ strength in flex/ext

Answer 4

Assessment for DC

Question 5

• ↓ hypertonicity
• ↓ trigger point activity
• ↓ fascial restrictions
• ↓ scarring adhesions
• ↑ ROM
• ↑ local circulation

Answer 5

Treatment Aims for DC

Question 6

• Pre-treatment wax bath
• Stripping – Pecs, Serratus Anterior, Scalenes, biceps, triceps, forearm, thenar/hypothenar mm
• X-finger fascia, bowing
• TP work to SA, RC, Lats, Palmaris Longus
• Frictions
• PROM

Answer 6

Massage Treatment for DC

Question 7

• Usually longitudinal sx incision, sometimes few horizontal incisions
• Splinted in extension
• Scar tissue fills in
• 24 days healing time
• Recurrance is common
• Tx in accordance with scar healing

Answer 7

Post Surgery Treatment for DC

Question 8

• Contrast baths: maintain tissue health

- ↑ ROM – stretches – use table (weight-bearing), stretch/strengthen as per postural analysis

Answer 8

Selfcare for DC