I'm going to have the fingers on my hand that are permanently bent injected to release the tissue. The surgeon will straighten the finger after the injection and then I'm supposed to go to therapy for a splint and some exercises. Are these the kind of exercises I can just do on my own? I don't have insurance coverage for hand therapy.
Dupuytren's contracture is a fairly common disorder of the fingers. It most often affects the ring or little finger, sometimes both, and often in both hands. It occurs most often in middle-aged, white men. This condition is seven times more common in men than women.
The condition commonly first shows up as a thick nodule (knob) or a short cord in the palm of the hand, just below the ring finger. More nodules form, and the tissues thicken and shorten until the finger cannot be fully straightened.
The contracture spreads to the joints of the finger, which can become permanently immobilized. Flexion contractures usually develop at the metacarpophalangeal (MCP) joints first. The MCP joints are what we usually refer to as the "knuckles." As the disease spreads from the palm down to the fingers, the proximal interphalangeal (PIP) joints start to be affected as well. The PIP joints are the middle joints between the knuckles and the interphalangeal (IP) joints (at the tips of the fingers).
Traditionally, treatment has been surgical release of the affected tissue. But more recently, collagenase injections have had some reportedly excellent results. This new treatment is getting close scrutiny because there is no known "cure" for Dupuytren's disease and the proximal interphalangeal (PIP) joint does not respond well to treatment. When just the metacarpophalangeal (MCP) joints are primarily involved, treatment has been quite successful.
But with the PIP joints, treatment in the past has not been as successful. This may be because contractures of the PIP joints also affect the collateral ligaments (on each side of the finger joint), the volar plate, and cause adhesions inside the joint. The volar plate is actually a very thick ligament that prevents hyperextension of the joint. This ligamentous structure also reinforces the joint capsule and gives the joint greater stability.
In a recent study, surgeons from the Philadelphia Hand Center at Thomas Jefferson Medical College reported on the effect of a three-part therapy treatment. Patients enrolled included 19 men and two women ranging in age from 37 to 80 years old. All had one or more proximal interphalangeal (PIP) joints stuck in flexion of at least 40 degrees or more. Twenty-two proximal interphalangeal (PIP) joints received one standard collagenase injection followed by manual cord rupture (performed by the surgeon).
Then they were treated by a hand therapist. The hand therapy consisted of wearing a custom-made splint (dorsal hand-based extension orthosis) at night and special exercises delivered and supervised by the therapist but also performed by the patient throughout the day at home. For day use, the hand orthosis was replaced by a smaller, finger splint to hold the PIP joint in full extension (straight).
Results measured by change in finger motion were impressive. Patients went from having severe flexion contractures (range of 40 to 80 degrees) down to zero for some patients (a range from zero to 55 degrees among all 22 fingers). A contracture means the finger is stuck and cannot move. A flexion contracture gives us the clinical picture that the patient's finger is bent by the amount of degrees mentioned and cannot straighten.
In viewing the results of this treatment compared to other studies utilizing surgery and postoperative splinting, there was an 88 per cent improvement in the patients who received this protocol of collagenase injection, manipulation, splinting, and exercises. This compared to a 44 per cent improvement with surgical intervention and splinting for the same problem.
Most hand therapists are willing to work with patients who have fixed means, no insurance, or other reasons why direct treatment isn't always possible. With splinting, a home exercise program, and careful supervision by the hand therapist, you may be able to get by with fewer visits. But it is not advised to skip hand therapy altogether. Dupuytren contractures are notorious for coming back. The cost of additional therapy to avoid surgery may be worth the extra out-of-pocket expense.
Terri M. Skirven, BS, et al. The Effect of a Therapy Protocol for Increasing Correction of Severely Contracted Proximal Interphalangeal Joints Caused by Dupuytren Disease and Treated with Collagenase Injection. In The Journal of hand Surgery. April 2013. Vol. 38A. No. 4. Pp. 684-689.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.