I'm faithfully wearing a night splint the hand therapist made for me after I had surgery for Dupuytren finger contracture. I'm starting to have some serious questions about this splint. It holds my fingers straight but I'm stiff in the mornings. It takes a while to get my fingers to bend again. Is that normal?
Routine hand therapy following surgical release of Dupuytren contractures usually includes the fabrication of a finger extension orthosis or splint for each patient. This customized splint may affect each joint of the hand differently resulting in some stiffness when the splint if first removed.
A review of studies focused on maintaining finger motion after surgery for Duyputren contracture(s) suggests that stiffness, pain, and slow recovery of function after surgical release is possible but not typical.
In fact, what is most surprising is that up to half of all patients lose significant amounts of finger extension after surgery with or without the splint. It's possible that wearing the splints for a longer period of time may be helpful. Perhaps the use of night positioning during the formation of new scar tissue requires longer time to change tissue length.
It is also possible that the type of splint makes a difference. A different design may provide more optimal joint motion. Since there are three joints in each finger, it is possible that the joints respond differently from one another in the type of splinting being used.
And since not all patients develop recurring contractures, there may be other factors at play here. Further research is needed to determine predictive factors (e.g., who is most likely to develop contractures again, who will get stiff with splinting) that can then be used to identify patients who should be splinted after surgery (and for how long).
Julie Collis, MSc (Hons) et al. The Effect of Night Extension Orthoses Following Surgical Release of Dupuytren Contracture: A Single-Center, Randomized, Controlled Trial. In The Journal of Hand Surgery. July 2013. Vol. 38A. No. 7. Pp. 1285-1294.
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