Dupuytren's Contracture (Exam 4)

Question 1

Dupuytren’s Contracture

Answer 1

Genetic link - genetic code that produces enzyme that tells the brain to release collagen

Affects the Longitudinal fibers of the palmar fascia
Palmar fascia is superficial - it is a disease of shallow tissue and is a contracture of the palmar fascia not a mechanical friction problem (trigger finger is deep b/c tendon is getting hung up on pulley’s)

It can occur in the feet (Ledderhose Disease) and 
male genitalia (Peyronie's disease)

Can be triggered by:
trauma (fx, surgery, sprain
ex: jammed finger

Trauma can cause a cycle of fibrotic tissue and the injury can be very mild

S/S: usually starts as tenderness at A1 pulley (at the MPJ) therefore it can get misdiagnosed as trigger finger

affects MP first so people start to pull down, often in small finger

nodules (thicken) and cords

Question 2

Occupational Impairment

Answer 2

• Difficulty grasping objects: comb, brush, steering wheel, cup, handles on tools etc
• Fingers get hung up on objects - putting hand in pocket, getting utensils out of drawer, trouble holding golf club
• Difficulty to load hand and hang on to small objects like change
• Advance stages can be painful and affect blood flow and skin integrity
• Affects both flexion and extension b/c tissues under can’t move freely - can also affect PIP

Question 3

OT Role Conservative

Answer 3

• Trying to prevent them from going to surgery
• Educate pt about the dx
• Teach hand flattening stretch on table
• Night splints
• Joint protection strategies
• AE
• Unlike joint contractors it is not reversible, we can only try to prevent further shortening

*Table stretch - try to push down and flatten into table
hold 20 seconds and 5 times

*Dont want to cause inflammation b/c it will make it worse

Question 4

Medical Interventions

Answer 4

Xiaflex injections: Collagenase Clostrodium Histolyticum
med that came out in the last 7-8 yrs
made out of gangrene bacteria, took harmful stuff out
the collagen from it attacks this fascia
-they manually manipulate, break adhesion and therapy
right after

 this is an aggressive treatment b/c the tendon can 
 rupture if doc gets too aggressive and xiaflex could
 potentially have a negative affect on the tendon tissue

 good tx for pt who are not in an advanced state

 it is painful and can cause bruising and bleeding,
 sometimes skin rips - hands can be black and blue
 when they get to us

Needle Aponeurotomy:
performed under local anesthesia
surgeon uses a needle to free fascia
risk of injuring tendon
could have risk of rupture to tendon or damage the
pulleys

Surgery to Remove Diseased Fascia:
clean and closed with primary intention
some docs leave a window (secondary intention)
will have xeroform and then adaptic
we still do movement once it is epithelialize (closed)
and can start strengthening

Question 5

Post OP

Answer 5

• Dressing changes/wound care
• Splinting - hand based
• Scar massage - zig-zag sutures
• Edema control - get rid of swelling
• Desensitization - finding marbles in rice or macaroni
• AROM (right after surgery)
• Progress activity once wound has healed fully to gentle
  strengthening

With severe Dupuytren’s don’t want to take them into full extension, start with little stretch and bring back gradually for 2 wk period, then replace with splint in full extension at night with movement during daytime