Best 5 Exercises for Dupuytren’s Contracture
What is the contracture of Dupuytren?
Dupuytren's contracture is a condition in which causes fibrosis in the palm of the hand causing the fingers to bend and curl towards the palm. It can also cause thickening of the palm's tissue, making it difficult to straighten your fingers. Sometimes the thickening can feel like thick cords of tissue in the palm.
Dupuytren's contracture usually affects men more than women and people over 40-years-old are at higher risk for developing it than younger people are. The exact cause of this condition isn't known, but doctors believe it may be related to genetics or aging-related changes in connective tissue (the material that binds together body tissues).
Who's at Risk for Dupuytren's Contracture?
The exact cause of Dupuytren's disease is unknown, but genetic factors such as age, gender, and family history may play a role. Smoking appears to increase your risk for developing the condition if you have this gene mutation (or have other risk factors). Diabetes has also been associated with an increased risk for developing Dupuytren's contracture; however, this association remains controversial because there are no clear data on whether diabetes itself causes Dupuytren's or whether people with Dupuytren's tend to develop diabetes more often than those without it. Alcohol consumption has also been linked with an increased risk for developing Dupuytren's contracture; however again this relationship needs further study before conclusions can be made about its significance in causing this disease.
Ultimately, there does appear to be a degree of randomness that some people just develop it, for no apparent reason. I am actually seeing a lady in clinic at the moment who is Danish and she talks about having Viking ancestors, and mentions that there is a higher prevalence in Viking ancestry.
How is the diagnosis of Dupuytren's Contracture made?
Physical examination is the most crucial aspect of diagnosing Dupuytren's contracture. Your Surrey Physio physiotherapist or osteopath will examine your hands and fingers, focusing on the skin on the palm of your hand (the palmar fascia). We’ll also feel for any tissue cords or fibrosis.
Any fingers can be affected, but most commonly it starts with the fourth and fifth fingers but can happen to the index finger too.
If a diagnosis of Dupuytren's contracture is suspected, other tests may be used but this is usually done by a consultant, and we would not require these tests to be done with regards to physiotherapy.
X-rays: These can help determine if there are any changes in bone structure that might indicate an underlying cause for your symptoms. It's also useful for ruling out other conditions like arthritis or rheumatoid arthritis (RA). To be honest, they are rarely used but are sometimes requested by the GP.
Ultrasound: An ultrasound uses sound waves to create images of structures inside the body without using x-rays and is rarely used to diagnose DC.
MRI: sometimes used by consultants to be super-thorough. We would not require an MRI.
How is Dupuytren's Contracture Treated?
In most cases, patients are just told to “manage it” or accept it. However, we firmly believe that physiotherapy can help. First, exercises can be used to stretch the fingers and massage to the palm may help too.
Also, shockwave could be useful, and we provide this at Surrey Physio for £65.00 per session (current price correct at time of writing the article, but check the price page for up-to-date pricing). Shockwave is a non-invasive treatment that uses sound waves to stimulate healing in affected areas. Several studies have investigated the effectiveness of showckwave in treating Dupuytren's contracture. One study found that shockwave reduced contracture and improved range of motion and quality of life for patients with Dupuytren's Disease palmar nodules. Other studies have shown that shockwave is able to reduce Dupuytren's contracture and improve function. Shockwave therapy proves to be a promising effective non-invasive therapy in the reduction of Dupuytren’s contracture.
Overall, while more research needs to be done, shockwave is a promising option for treating Dupuytren's contracture that we use at Surrey Physio and it’s well worth trying.
If you have severe cases of Dupuytren's contracture that don't respond to conservative treatment, your doctor may recommend surgery as well as other options such as wearing splints or braces on your hands at night to keep them straightened out while you sleep. Surgery has been shown to improve hand function in some patients who undergo this procedure; however, it does come with some risks including infection and scarring around the incision site (which may require additional treatment).
The most common surgical treatment is called palmar fasciectomy, which involves removing the affected tissue from your palm. This procedure can be done in an outpatient setting and usually takes less than an hour to complete. There are mixed results with them. According to the NHS, the surgery is not recommended as DC tends to come back so results can be short term. However, some patients do report better results than research would suggest.
What are the Complications of Dupuytren's Contracture?
Appearance: the fingers look clawed. This isn’t great but many people just accept it as part of ageing.
Function: the function of the fingers is compromised as they don’t extend fully.
Weakness: as you lose strength in your hand, it's harder to perform tasks such as opening jars and lifting items without dropping them.
Joint Damage: Over time, Dupuytren's contracture may cause degenerative changes to joints such as the knuckles and fingers, and even arthritis if untreated for too long.
Recurrence: If you have Dupuytren's contracture once, there's a chance it will come back again later on in life; however, this isn't always true, it depends on how severe your first case was and whether or not you treated it properly at first.
How Can Dupuytren's Contracture be Prevented?
In some people, it just happens, especially if there is a genetic tendency. But for others, basically just live a healthy lifestyle and exercise.
- Avoid alcohol and smoking.
- Maintain a healthy weight.
- Exercise regularly, especially the hands and fingers.
Best 5 Exercises for Dupuytren's Contracture
1. Finger Extensions
Bend your whole finger backwards and hold the stretch. You can do this on any one or all of your fingers. This exercise will help mobilise your finger. Start with the outer fingers first like the 5th digit and progress inwards if the Dupuytren’s is worse on the outside. Hold each stretch for 30 seconds, and repeat three times per finger, daily.
2. Active Finger Extensions
Place your injured hand on a flat surface, lift all your fingers upwards off the surface together. Use this exercise to strengthen your finger tendons. Repeat twenty times on each hand, daily.
3. Hand Massage
Use your thumb on your opposite hand to massage into the soft palm of your affected hand. Perform circular motions, and focus on areas of tightness or tenderness. This is a way to massage the palm of your hand. Perform for two minutes per day.
4. Finger Abduction Active
Start with your fingers together. Spread all your fingers wide apart from each other. Use this exercise to stretch your fingers out. Repeat twenty times, daily.
5. Finger Extension with Band
Place a band around your fingers with your finger pads facing towards you. Extend your fingers against the resistance of the band. This is a strengthening exercise for the fingers. Hold for 30 seconds and repeat three times.
What is the Prognosis for Dupuytren's Contracture?
The prognosis for Dupuytren's contracture depends on the severity of your condition but it can be progressive and get worse, and often does. Recurrence Risk: The risk of recurrence is high, especially if you have another family member with the disease. If you do have a family history of Dupuytren's contracture, talk to one of our physiotherapists about ways to reduce this risk.
Exercises help slow down the rate of progression but won’t cure the problem. Surgery can part-cure it, but the DC may come back. The success rate for surgery depends on several factors including age and severity of symptoms at the time of surgery; however, most patients are pleased with their results after undergoing an operation for Dupuytren's Contracture.
Conclusion
Dupuytren's contracture is a condition that affects the fingers. It causes the palm and fingers to become stiff, making it difficult to straighten them out. At Surrey Physio we have a great deal of experience helping people who have Dupuytren’s and we will happily see you for advice, guidance, and treatment.
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If you are a patient, in pain, or suffering with Dupuytren’s, please call us to discuss your case further. Surrey Physio have an amazing team of therapists to help you recover from pain, and get you back to living a normal life. Call us on 0208 685 6930 or click the link at the top to book online.)