Blog Category

Month: April 2018

Categories
Conditions General

Can Dupuytren’s Contracture Be Cured?

Read Blog

Dupuytren’s contracture is a disease of the hand resulting in a deformity of the finger. It may have originated with the Vikings in Scandinavia and spread across Europe and then the world, as Viking influence spread. Whatever its origins, it can be a disabling and distressing condition.

If you have the symptoms or have had a diagnosis of Dupuytren’s contracture you may be wondering if it is curable. Read on to learn more about the condition and the answer to your question.

What is Dupuytren’s Contracture?

The condition, Dupuytren’s contracture, affects the fingers and hands. One, or sometimes more, fingers bend towards the palm of the hand. It can affect either or both hands and, in some cases, it can affect the thumb.

It usually starts when a nodule or hard lump forms under the skin of the hand. This small lump can be around a quarter of an inch in diameter. It can feel tender although this usually passes.

More nodules may develop. These nodules are benign (non-cancerous) and generally do not pose a problem at this stage. Over time the nodules can form an extended cord that runs along a finger or the thumb.

The cord can tighten or shorten bending the finger or thumb. The contraction pulls the finger or thumb towards the palm. Although this is generally painless it is progressive.

As the Dupuytren’s contracture gets worse the finger or thumb bends ever more towards the palm and into a permanently bent position. This can make using the hand difficult, especially when extending the hand. Playing a musical instrument, swimming or even shaking someone’s hand can be problematic.

What Are the Causes?

Other than the genetic background to Dupuytren’s contracture, we know little about the causes. It does often run in families. If you have the gene for Dupuytren’s contracture there are some factors that make it more likely.

It tends to affect older men, over 50 years of age. People with diabetes, epilepsy or who drink heavily or smoke have an increased chance of developing the condition. However, lots of people with the condition don’t have these problems.

Who Is at Risk?

The condition is quite common and although most cases are men over 50, women are also affected and there have been cases of children with the condition. It is more common in people with a northern European ancestry.

Because there is a genetic aspect to the disease it may not be preventable but avoiding some of the risk factors such as heavy drinking and smoking may reduce the risk.

Getting a Diagnosis

The key symptoms are:

  • Nodules in the palm of the hand
  • Lumps or pitted skin surface
  • Thick skin
  • Fingers bent towards the palm

If you have any of the symptoms described here, the first step is to have your hand examined by a physician. An examination will include a discussion with you about your symptoms and how they affect your life. Different people find that daily activities are more or less affected by the condition.

If the diagnosis is Dupuytren’s Contracture, the physician will assess the severity. In many mild cases, the physician will recommend no treatment until the severity gets worse. In other cases where the condition is more advanced, there is a range of possible treatments.

What Are the Treatments?

Following a diagnosis, your physician may suggest non-surgical treatment or a minor procedure called needle fasciotomy. Surgery is the recommendation in severe cases. Surgery options include open fasciotomy or fasciectomy.

Non-Surgical Treatment

Non-surgical treatments include radiation therapy or an injection of collagenase clostridium histolyticum.

Radiation Therapy

Radiation therapy may delay or prevent the advancement of the condition and so avoid surgery.

The treatment is believed to reduce the production of collagen and therefore the development of the cords. The treatment does not lead to a reduction of symptoms in all cases. There are also some minor side effects including dry and flaking skin.

Collagenase Clostridium Histolyticum

Xiaflex or collagenase clostridium histolyticum is an enzyme. An injection into the cords in the hand weakens the cord. Follow up treatment involves physically extending the range of movement of the finger.

Your physician will advise on the exact post injection procedures. It’s important to follow these precisely. Further injections may be administered.

Some side effects may be swelling, itching and some bruising and pain. Less common side effects include feelings of sickness or dizziness.

The benefits of collagenase clostridium histolyticum may be to increase movement of the fingers and delay or avoid the need for surgery.

Surgical Treatments

There are several surgical options your physician may consider.

Needle Fasciotomy

This procedure does not need an overnight hospital stay. A local anesthetic means the patient remains conscious throughout.

During the procedure, the surgeon inserts a needle or fine blade into the problem fibrous cord. This weakens the cord and reduces the tendency to pull the finger towards the palm.

The benefits of this procedure are:

  • Less impact than major surgery
  • Quick recovery
  • Less risk of complications
  • Improved use of fingers

The treatment has some effect but many people will experience a return of the contracture.

Open Fasciotomy

More serious cases need more invasive surgery. The aim is to have a long-term benefit but as with any surgery, there are risks, as well as potential benefits.

The operation can be under a local anesthetic and does not usually require admission to hospital. After the surgeon makes an incision in the hand, they cut the fibrous cord, weakening it. This allows straightening of the fingers.

The wound in the hand is then stitched and dressed. There will be some post-operative care required including removal of the stitches. The healing process takes longer than a needle fasciotomy and there will be some scaring.

Fasciectomy

This procedure is the most invasive of the options available. There are three types of fasciectomy.

During a regional fasciectomy the surgeon removes the affected tissue through a large incision. This is either using a local anesthetic which numbs the whole arm or alternatively under a general anesthetic. This means the patient is unconscious during the operation.

This type of surgery is the most common type used. It is a more invasive operation than an open fasciotomy and so it comes with a higher risk of complications.

A segmental fasciectomy is where the surgeon makes small cuts in the hand and removes small pieces of affected tissue. A dermofasciectomy is where the skin is also removed along with the affected fibrous cord. A skin graft, taken from another part of the body, covers the wound.

The effectiveness of fasciectomy is greater than other procedures with longer lasting results. There are lower rates of the Dupuytren’s Contracture returning than for non-surgical or other surgical procedures. A physician will discuss the risks of surgery with you prior to making a decision to operate.

Recovery

Recovery after treatment can take some time. After surgery, you may need physiotherapy to improve the range of movement. This can take the form of manipulation and exercises.

The fingers may be bandaged to a plastic strip for all or part of the day and night. This splinting may help the position of the fingers as well as the formation of scar tissue.

After recovery from surgery, there is a chance that the process that causes Dupuytren’s contracture will continue. This means that the condition could return.

A return of the condition is most likely with needle fasciotomy and least likely with fasciectomy.

Can Dupuytren’s Contracture Be Cured?

As Dupuytren’s contracture is probably caused by a genetic pre-condition there is no simple cure. The treatments described here have different degrees of success and for different time spans. This depends on the degree of advancement and severity of the condition.

All individuals have different experiences of how debilitating the condition is and how beneficial any improvement is. Different people respond to treatment differently and also vary in their recovery and experience of complications.

Research indicates that while there is no cure for Dupuytren’s disease it is possible to achieve a beneficial outcome following treatment. A reduction in inconvenient and uncomfortable symptoms is desirable for most people. Slowing down the progression of the condition is also very welcome.

What Should You Do If You Have Symptoms?

Dupuytren’s contracture can interfere with your ability to do everyday tasks such as driving, washing or dressing. It can impact work if it makes using a keyboard or tools difficult. It can have a social impact if it stops you shaking hands comfortably.

There may not be a complete cure but there is a range of treatments that you can discuss with a physician. Understanding your condition and getting a professional diagnosis is key.

To talk to someone about your symptoms, call or fill out our form.

Contact Us

Categories
Conditions General

Can Dupuytren’s Contracture Be Painful?

Read Blog

Is Dupuytren’s contracture painful in some instances? Find out what can be done about it.

Have you ever noticed small, tender bumps in the fleshy part of your palms?

Those lumps could be a sign of Dupuytren’s contracture (DC), a condition in the hands that can result in limited functioning or your muscles. And, in some cases, can cause pain.

It’s important to learn everything you can about this condition to be able to prevent it and/or treat it. You may only have the beginning symptoms, but now is the most important time to understand what’s going on in your hands.

To learn how to treat your dupuytren contracture, keep reading.

What is Dupuytren’s Contracture?

Our hands have fibrous bands that stretch from your palm to the ends of your fingers. These bands are flexible and elastic when they’re healthy.

When someone has DC, those bands of tissue develop lumps that eventually cause the tissue to grow thicker. Those lumps can sometimes feel sore or tender, or not feel like anything at all. However, they are an indication of onset DC.

As the tissue becomes thicker, it contracts the bands that connect to your fingers causing them to curl inwards.

In severe cases, it causes hand deformity and loss of mobility in the hands.

What Causes It?

There hasn’t been a direct cause discovered for Dupuytren’s contracture yet. We do know that it isn’t caused by overuse of the hands or from an injury.

Research has shown that it is more common in men than women, especially men over the age of 50.

It’s also been proven to be hereditary; people of Northern Europe descent are more likely to have Dupuytren’s contracture.

As with many health conditions, the risk factors include smoking, alcohol consumption, and diabetes. It’s also been known to exist alongside other hand conditions like arthritis.

Symptoms

The first sign of DC is noticing 1-2 small lumps that develop in the palm of your hand. These lumps might be tender, or they may not be sensitive at all.

Your pinky and ring fingers are more commonly affected than your thumb, index, and middle fingers. You may notice some stiffness in these fingers.

It’s important you see a doctor as soon as you notice these lumps in your hands. Dupuytren’s contracture usually develops slowly over multiple years; monitoring it from the beginning will help doctors know what kind of treatment will work for you.

Is Dupuytren’s Contracture Painful?

There’s been some controversy over whether DC is a painful condition. For most patients, it is not painful. Your hands may feel stiff, tender, or uncomfortable.

In the minority of cases, there is pain present in the hands. The lumps can sometimes be very sensitive and sore. What we know from research is that if you experience pain at the onset of the condition, along with itchiness, that may be an indication that it is a more aggressive form of DC.

When to See a Doctor

You should see your family doctor as soon as you notice any lumps in your palms. They will likely do an exam on your hands to accurately diagnose the lumps and determine a solution.

The exam consists of your doctor checking the mobility of your hands, wrists, and fingers. They will feel the lumps and record how many. They may ask you to place your palm on the table to see if your hand can lay flat or ask you to pick up small items only using your thumb and a finger in a pinching motion.

These exams will need to happen regularly since this condition develops over many years.

Knowing your baseline exam records will help doctors see how fast the condition is developing; recording your symptoms can help dictate which method of treatment you use.

Treatment

Unfortunately, there is no cure for dupuytren contracture.

Even with the best treatments, there’s always a chance it could return. Luckily, it isn’t a life-threatening condition and many patients continue to lead full and happy lives with it.

There are a few different treatments available as well as preventative techniques. We’ll address each method in detail, so you can make a more informed decision, along with your doctor, on which one is right for you.

1. Preventative Measures

If you have a familial history of developing dupuytren contracture, it’s wise to go the extra mile with your hand health.

Stretching

Conservative stretching is a great way to maintain the flexibility in your hand’s fibrous bands. DC causes these bands to lose their elasticity, so stretching can help prolong or prevent the onset.

Start by gently bending the hand backward at the wrist to stretch out the bottom of your palm. Then, bend each finger backward to gently stretch the bands that connect the fingers to the palm. Bend the hand forward at the wrist to stretch the back of your hand.

Another beneficial stretch is to place your hand as flat as possible on a table, then lift up the palm while your fingertips remain on the surface. This feels wonderful on your finger tissues as well as your palm.

Massage

Whenever you notice soreness or stiffness in your hands, it can be soothing to give yourself a hand massage. Using anti-inflammatory creams, or lanolin ointment can reduce the tenderness.

Try using the thumb of your opposite hand to massage your palm and roll out any tension or stiffness. Massage the tendon upwards and downwards along the fingers.

In addition to stretching and massaging, avoid using a tight grip to lift anything unless it has cushion tape. Anytime you must do a task that requires gripping, consider using heavily padded gloves.

2. Medication

Your doctor might want to start treating your dupuytren contracture with medication since it’s less invasive than surgery. As mentioned above, there is no cure for DC, but these medications can greatly improve your condition.

Corticosteroid

One type of medication is a corticosteroid injection. This is an anti-inflammatory agent which will reduce the swelling and tenderness in your hands.

Although it does an excellent job of reducing any pain, it cannot reverse the contraction that has already occurred. However, it may prevent future contraction.

Collagenase

Another injection your doctor might choose is a collagenase injection. This medicine is made up of enzymes that dissolve the thickened tissue by weakening the tight bands.

Although it is a beneficial treatment, it can cause swelling, bleeding, and bruising in your hands.

With any type of injection, you may feel pain at the injection site. Some doctors will offer a topical anesthetic for patients who can’t tolerate pain from needles.

3. Traditional Dupuytren Contracture Surgery

If you’ve tried medicinal treatments and they didn’t improve your condition, it may be time to consider surgery.

The traditional, and most invasive, surgery for DC requires the surgeon to create an open incision and cut off the excess thick tissue in your palms. Patients can be put under anesthesia for this process.

As with any surgery, this one also comes with some risks: infection in the incision, damage to the nerves, and even potentially permanent finger stiffness. You should weigh the risks against the benefits to see if this treatment option is worth it to you.

Most patients fully recover after several months post-surgery and endure some swelling and stiffness after the procedure. Unfortunately, research has stated that the condition recurrence rate is 20% of people who have this surgery.

Physical therapy is usually required after surgery to help heal the hands and get them accustomed to broader functioning.

4. Aponeurotomy

This is another type of surgery that is less invasive than the traditional procedure, sometimes referred to as needling.

A specialized hand surgeon will use sharp needles to penetrate through the skin and cut loose the tight bands in your palms. There is no open incision, so the recovery process is faster than the traditional procedure.

Although it’s less invasive, it is also less effective when used to treat DC on its own. In conjunction with corticosteroid injections and self-massage, the outlook is much more successful.

5. Radiation

Another option for less invasive treatment is radiation therapy. Using low energy, the radiation can help reduce symptoms or halt them before they get worse. This often involves treating the lumps or nodules, and the bands in your hands.

Although this is an option for dupuytren contracture treatment, it hasn’t been studied nearly as much as the previous four options.

Interested in Learning More?

The hands are vulnerable to a variety of conditions besides dupuytren contracture.

Since your hands require the optimal functioning of so many different parts (muscles, nerves, bands, nails, etc.) it’s best to always be aware of any potential symptoms you may be experiencing.

Never be afraid to ask your doctor to look into what you’re experiencing, it could be the difference between having healthy hands and potentially losing function of them.

If you’d like to learn more about our services or have questions about possible treatment options, call us today!

Categories
Conditions Fingers General Hands

Is Dupuytren’s Contracture The Same As Trigger Finger?

Read Blog

Is Dupuytren Contracture the same as Trigger Finger?

Are Dupuytren contracture and trigger finger the same thing?
The answer to that question is no.

Upon first glance, these two things might seem very similar, but they are actually very different medical conditions. In fact, the only similarity is that they both affect finger flexion.

Trigger finger involves the tendons, and Dupuytren contractor involves the tissue. Trigger finger is usually brought about by finger injuries, but Dupuytren comes about a little more mysteriously. Medical professionals aren’t entirely sure what causes Dupuytren.

So let’s spend a bit of time breaking these two conditions down.

Take a look at this guide to find the differences between trigger finger and Dupuytren and to learn how each condition can be treated.

What Is Trigger Finger?

Trigger finger is also known as stenosing tenosynovitis, and it causes one or more of your fingers to get stuck in a bent position.

But doesn’t make them completely stuck. People with trigger finger can usually still straighten their fingers, though it may take more work than normal and will make a snapping or clicking sound, similar to the trigger of a gun being pulled.

When your finger tendons pass from your arm through the palm of your hand, they are surrounded by a protective fibrous sheath.

Trigger finger occurs when inflammation narrows the sheath around the tendons and a nodule forms, usually from injury. Flexing your fingers forces the nodule to slide through the narrow sheath with a snap.

This is most common in the index and middle finger and the thumb (then called trigger thumb).

What is Dupuytren Contracture?

Dupuytren also causes one or more of your fingers to be stuck in a bent position, but that’s where the similarities stop.

Dupuytren can take years to develop completely, and it’s a hand deformity that affects the tissue in the palm of your hand.

This condition starts when that tissue starts to form knots under the skin of your palm. As these knots continue to form, they will create a cord that pulls one or two fingers into a bent position.

Unlike trigger finger, these bent fingers can’t be fully straightened again when this happens. Because of this, everyday activities, even ones as simple as shaking someone’s hand, become difficult.

This condition is most common in the pink and ring finger.

Symptoms of Trigger Finger

Though trigger finger is most common in the first two fingers and thumb, it can also develop in other fingers. More than one finger and even both hands can be affected at the same time.

Most people experience trigger finger in the dominant hand. Here are some of the symptoms that come along with trigger finger.

  • Your finger clicks when you move it
  • Stiffness, especially when you first wake up
  • A bump at the base of the finger
  • Tenderness
  • Finger sticking in a bent position then popping out of it
  • Bent finger you can’t straighten

You will most likely notice trigger finger symptoms when you’re grasping objects or flexing your fingers in the morning.

Symptoms of Dupuytren Contracture

These symptoms might be harder to notice because they can form over multiple years. Because the onset is slow, you might not realize you have these symptoms until they are more pronounced.

Here are some of the things you should look out for.

  • Thickening skin on the palm
  • Dimpled or puckered skin on the palm
  • A sensitive lump of tissue forms on the palm (usually isn’t painful)
  • A noticeable cord forms under the skin that reaches your fingers
  • Fingers that are pulled toward the palm

This can also affect any finger on either hand, though it is much rarer in your index finger and thumb. If someone has it in both hands, one hand is normally worse than the other.

What Causes Trigger Finger?

Trigger finger is usually caused by overuse and injury.

In some cases, all it takes is one large injury to bring about trigger finger, but sometimes it forms from small or repeated injuries.

What Causes Dupuytren Contracture?

There is no clear cause for Dupuytren. This condition doesn’t seem to be connected with any injuries.

Who’s More Likely to Get Trigger Finger?

Anyone can suffer from trigger finger, but it’s more likely to occur in females and people with diabetes. People with jobs that require gripping repetitively are more likely to get trigger finger than people who don’t make those same hand movements as often.

Who’s More Likely to Get Dupuytren Contracture?

Although medical professionals still don’t know what exactly causes Dupuytren, they do have some ideas of who is at more risk to experience this condition.

It is most commonly found in European men who are older than 50. It also seems to run in a family line. In other words, people with family members that have had Dupuytren are more likely to get it themselves.

Like trigger finger, people with diabetes are also more likely to get Dupuytren.

Can You Have Trigger Finger and Dupuytren Contracture at the Same Time?

These two conditions are not the same thing, but a person can experience both trigger finger and Dupuytren contracture at the same time.

How Is Trigger Finger Diagnosed?

In most cases, doctors don’t have to perform any serious tests. They can diagnose your hand after a simple physical exam.

This exam might include you opening your hands and closing your hands, and the doctor will check for things like smooth motion, locking fingers, and places of pain.

The doctor will probably look for a lump in your palm near the base of the afflicted finger.

After the doctor looks for these symptoms, they will be able to diagnose you with trigger finger.

How Is Dupuytren Contracture Diagnosed?

The diagnoses for Dupuytren is also fairly simple and doesn’t require anything elaborate. Again, all the doctor has to do is perform a physical exam on your hand.

Your doctor will look for common symptoms of Dupuytren, such as dimpled or puckered skin on your palm, tissue knots in your palm, and fingers that are locked in a bent position.

If you’re in the early stages of Dupuytren, the doctor may have you flatten your hand against a tabletop to see how far your fingers can straighten. Inability to straighten your fingers completely is a sure sign you have Dupuytren.

Finger Trigger Treatments

The treatments for trigger finger depend on the severity of your particular case. If the trigger finger hasn’t progressed to a serious stage, the doctor might suggest some finger and hand therapy.

This could include things like:

  • A finger splint to wear at night to help your tendons relax
  • Stretching exercises to keep the mobility of your fingers
  • Rest to avoid overusing or injuring your fingers

If the trigger finger is more severe, your doctor might try a steroid injection. They will inject this medication into the constricted sheath, which will help it relax and provide smoother movement. An injection like this can fix the problem for over a year.

In some cases, your doctor might also try a percutaneous release. This means the doctor will, after numbing your finger, insert a needle into the tissue and break the nodule that’s preventing free movement.

Lastly, there is also an option for surgery. During this surgery, the doctor will create a tiny incision on your finger and cut open the damaged sheath.

Dupuytren Contracture Treatments

If you don’t have a serious case of Dupuytren, you may not need any treatment at all. As long as your condition isn’t making it difficult to perform daily tasks and has no pain, your hand may do better on its own.

However, more serious cases require treatments that break apart the knotted tissue and the cord that’s pulling the fingers into a bent position. There are several different ways to do this.

Needling

A doctor will insert a needle into your palm and use it to break apart the knotted tissue at the base of your afflicted fingers. This is not a permanent fix because the cord will often reform. However, the treatment can be repeated many times.

Doctors may recommend this treatment because it doesn’t take a lot of time to heal or recuperate the hand. It can also be done on several fingers at the same time, so if you have a lot of fingers affected by Dupuytren, this may be a good option.

Enzyme Treatments

These enzymes can be injected into the cord of tissue in your palm. They will then weaken the cord, which makes it easier for your doctor to move your fingers and break the cord.

Surgery

Doctors use this treatment for people with advanced forms of Dupuytren. During the surgery, they will remove the knotted tissue in your hand. This treatment lasts longer than both needling and enzyme injections.

This surgery does require physical therapy and a longer recovery time than other methods.

If You Notice Any Symptoms, Go See a Doctor

Whether you experience symptoms of trigger finger or Dupuytren contracture, you should make an appointment with a doctor right away. They will be able to give you a proper diagnosis and a medical plan for the future.

Experience finger problems that don’t seem to match either of these conditions? Check out this guide to make sure you don’t have nerve damage.

Categories
Conditions Fingers General Hands

What are the Causes of Dupuytren’s Contracture?

Read Blog

What causes Dupuytren Contracture? Click here to learn more.

Do you think you’re one of the approximately seven percent of Americans dealing with Dupuytren contracture? Do you even know what this condition is?

Read on to learn more about this surprisingly common condition and get some useful information on how to treat it and improve your quality of life.

What is Dupuytren Contracture?

Let’s start by clearing up what Dupuytren contracture actually is.

Dupuytren contracture, which is also known as Dupuytren’s disease, is a condition that involves the tightening and thickening of the fascia (connective tissue) of the fingers and palm of the hand.

Normally, fascia is very elastic. But, for people suffering from this condition, the fascia is tight, to the point where it can cause the fingers to curl inward. It can even cause severe deformities that limit overall hand function.

Common Causes

Dupuytren’s disease doesn’t have a single known cause. But, researchers have found that it often runs in families, and people of certain heritages are more likely to develop it.

Those who are more susceptible to the condition include people of Northern European or Scandinavian descent.

Certain illnesses and lifestyle factors can influence a person’s likelihood of Dupuytren’s contracture, too. Common ones include:

  • Excessive alcohol consumption
  • Diabetes
  • Epilepsy and seizure disorders
  • Smoking

Men who are in their forties or older are also more likely to develop Dupuytren’s disease than women. For both genders, the chances of being diagnosed increase with age.

Symptoms

How do you know if you have Dupuytren’s contracture?

Most people start by noticing small lumps, or nodules, under the skin on the palm of their hand. The nodules will usually be sore and tender at first, but the discomfort will subside with time.

After they first develop, these nodules will cause tough bands of connective tissue to appear under the skin. These bands will cause the fingers to curl inward and will hinder one’s ability to straighten their fingers.

The ring and pinkie fingers often are affected first.

Dupuytren’s contracture usually affects both hands. But, one hand may present more serious symptoms than the other.

As the condition progresses, it can become difficult to perform everyday tasks like placing your hands in your pockets or picking up large objects. Even actions like shaking hands, wearing gloves, or placing your hand flat on a surface become challenging.

When Should You See a Doctor?

The sooner you speak to a doctor about your condition, the sooner you can start treatment and avoid the debilitating symptoms that occur as the disease progresses.

If you notice lumps on your palm — even if they’re not painful — you should make an appointment with your doctor.

If you’re already experiencing more advanced symptoms, like difficulty straightening the fingers or grasping objects, it’s even more important for you to make an appointment.

Diagnosis

When you visit a doctor, he or she will examine your wrists, hands, and fingers. They’ll pay special attention to the palms to check for nodules and count how many are currently present.

The doctor will also most likely have you perform a series of tasks to see how far the disease has progressed. Common tests include:

  • Placing your hand flat on a table
  • Grasping and pinching items with the hands and fingers
  • Checking the amount of feeling you have in the fingers and thumbs
  • Measuring range of motion

The doctor will repeat these tests and exams regularly to see if your condition is improving or getting worse.

Nonsurgical Treatment Options

Dupuytren’s contracture doesn’t have a cure. But, there are also a number of nonsurgical treatment options that the doctor will suggest first to help you manage your condition and improve your quality of life.

Some common nonsurgical treatments that the doctor will likely start with include:

Stretching

When Dupuytren’s disease is in its earliest stages, many doctors start by recommending regular stretching exercises to improve range of motion and slow the disease’s progression.

Common exercises include flexion exercise, grip strengthening exercises, and isolation exercises.

Steroid Injections

An injection of corticosteroids, a type of anti-inflammatory medication, can help reduce the size of nodules when the disease is in its early stages. They also can help slow the progression of Dupuytren’s contracture.

But, if the thickened tissue has already formed, or the fingers are already starting to curl, steroid injections don’t seem to be particularly effective.

Enzyme Injections

Your doctor may also try injecting an enzyme mixture into the thickened tissue to try and loosen it up. After the injection, doctors sometimes try to stretch and straighten out the fingers.

Enzyme injections can be effective, but most people require two to three of them before they see improvement. They also come with some minor side effects like swelling, bruising, and bleeding.

Less Effective Treatment Options

Some doctors recommend treatments like low energy radiation, ultrasound, or Vitamin E cream to treat Dupuytren contracture. These treatments are not well researched and generally are not as effective as the options mentioned above.

It’s also important to avoid splinting your fingers. It might seem like a good idea to force the fingers to straighten. But, the force from the splint can actually backfire and cause the finger to curl inward faster.

Surgical Treatment Options

After trying nonsurgical treatment options, your doctor may suggest surgical intervention if your condition doesn’t seem to be improving.

There are three different types of surgery that doctors perform to treat Dupuytren contracture:

Needle Fasciotomy

Also known as a percutaneous needle fasciotomy or a needle aponeurotomy, this is an outpatient procedure that is performed with just a local anesthetic.

During this procedure, the doctor will insert a fine needle or very sharp blade into the connective tissue of the palm or fingers. They’ll then use the needle or blade to divide the bands and release the tension that causes the hands to curl.

Some of the benefits of this procedure include:

  • Fewer deformities of the hand
  • Faster recovery
  • Low risk of complication

A needle fasciotomy is also a good option for older patients for whom extensive surgery is not safe.

Open Fasciotomy

Another option is an open fasciotomy. This procedure is usually used for more severe cases. There is more long-term relief from an open fasciotomy compared to a needle fasciotomy, but it’s also more extensive.

An open fasciotomy is an outpatient procedure, like a needle fasciotomy, and it’s performed under local anesthetic.

During this procedure, the doctor will create an incision to access and divide the thickened connective tissue to improve your ability to straighten your fingers. They’ll then seal the wound with stitches and apply a dressing.

Since the wound is larger from this procedure, recovery time is a bit longer. You’ll also need to plan for a second appointment to have the stitches removed, and you’ll likely have a scar left over.

Fasciectomy

The most invasive surgical option for Dupuytren contracture involves removing the thickened bands of tissue altogether.

There are three different variations of a fasciectomy:

  • Regional: The doctor removes the affected connective tissue through one large incision
  • Segmental: The doctor removes small segments of tissue through one or more small cuts
  • Dermofasciectomy: The doctor removes affected connective tissue and overlying skin that may be damaged, then seals the wound with a skin graft

Unlike the other two options, a fasciectomy will most often be carried out under general anesthetic. You’ll be unconscious during the procedure and won’t feel any pain.

Because of the use of general anesthesia, there are more risks that come with a fasciectomy. But, complications are still unlikely, and the results of a fasciectomy usually last longer than the results of a needle or open fasciotomy.

Potential Complications

Complications are quite rare. But, the most frequently experienced ones include:

  • Infection
  • Potential nerve or blood vessel injury
  • Permanent stiffness in the fingers

In the months following your surgery, it’s common to experience some swelling and discomfort.

Recovering from Surgery

Most people see significant improvement in the range of motion in their fingers following surgical intervention, especially with the help of physical and occupational therapy.

After surgery, you’ll probably be able to return to your daily activities, including driving, after about three weeks. Recovery can be a bit longer for people who have had skin grafts.

You should refrain from heavy manual labor and intense physical activity for about six weeks to ensure proper healing.

Chances of Recurrence

Surgery is highly beneficial, especially for people who are experiencing limitations in their daily activities as a result of Dupuytren contracture.

However, it’s important to note that there is a chance that the condition will return. People with a strong family history or those who had particularly severe contractures are more likely to experience a recurrence after surgery.

The chances of recurrence are also higher in needle fasciotomies than fasciectomies. Dermofasciectomy has the lowest risk of recurrent (less than one in ten).

Get Treatment for Dupuytren Contracture Today

Do you think you’re suffering from Dupuytren contracture? Are you looking for treatment and relief from your symptoms?

If so, contact us today at Arora Hand Surgery to schedule a consultation. We proudly serve people throughout the state of Michigan, and we’re eager to help you improve your symptoms and start feeling your best.

Categories
General Wrists

Common Broken Wrist Symptoms

Read Blog

At Arora Hand Surgery, we treat a variety of conditions and injuries of the hands and wrists.  Broken wrists are a common injury.  They are usually caused by falls.  People tend to try and catch themselves with their open hands when falling.  The delicate wrist bones can fracture or crack under the pressure.  If you are not aware of what the broken wrist symptoms are, it is easy to not realize the severity of your injury.
 
 

Risk Factors for Wrist Injury

People who play certain sports are more susceptible to injury of the wrist.  High-risk sporting activities include:

  • Soccer
  • Football
  • Equestrian sports
  • Rugby
  • Roller and inline skating
  • Hockey
  • Trampolining

Those with osteoporosis, which is a condition causing thinning of the bones, are at higher risk of injury.

It is important that fractured or broken wrists be treated as soon as possible.  When the injury heals without proper care, the bones can fuse together misaligned.  Improperly aligned bones, in a crucial area such as the wrist, can make even simple activities difficult. Daily tasks like writing or using buttons can become very difficult.

Potential complications can include:

  • Osteoarthritis
  • Perpetual stiffness of the wrist
  • Aching
  • Disability
  • Nerve damage
  • Damage to blood vessels
  • Decreased range of motion
  • Decreased grip strength

The earlier you seek treatment, the more likely serious conditions can be avoided.

A Closer Look at Broken Wrist Symptoms

The first step in preventing further injury or disability to your wrist is identifying the symptoms of a fracture or break.  The first and most obvious signs often occur immediately following the injury.  You may experience severe pain that is exasperated by trying to move your wrist or hand.  You may also have pain when trying to grip things, squeeze or clench your fists.  Additional signs you should look for include:

  • Tenderness in the area
  • Swelling of the hand or wrist
  • Bruising
  • Stiffness of the fingers or thumb
  • Inability to move the fingers or thumb
  • Numbness in your fingers
  • Numbness in your hand

Whenever there is a deformity in the area such as a bent wrist or crooked finger, it is a clear indication of damage.

If there is any question about the possibility of a fracture or break of the wrist, you should see our doctor as soon as possible.  A loss of regular motor control, numbness, or swelling are serious signs that should never be ignored.  Failing to do so could lead to long-term consequences.

If you are experiencing any of the broken wrist symptoms that were discussed here, or other unexplained symptoms, we urge you to call us at Arora Hand Surgery in West Bloomfield, Howell, St. Clair Shores, or Macomb. Contact us today to schedule your appointment.

Categories
Fingers General

How to Treat a Broken Knuckle

Read Blog

You use your hands all day long. It is likely that you will eventually injure your fingers. If that injury results in a broken knuckle, it’s good to know how to treat a broken knuckle. The treatment provided will vary depending on a number of factors. These include how the knuckle was broken, how old you are when the break occurs, what you do for work, and how functional you need your fingers to be.

The most common option for treating a broken knuckle is called knuckle strapping. As the name implies, this treatment involves connecting the damaged finger to a healthy finger using tape or a strap. The two fingers are strapped together for multiple weeks or more.

There are some instances where strapping is not a practical option. In these cases, splints or a cast may be used. But in some cases, the break is so serious that a more complicated remedy is needed. This is where surgery comes into the picture.

There are a number of options for fixing broken knuckles. Just as an example, metal bars may be placed between pins with the goal of keeping the bone and any bone fragments in a fixed position during the healing process.

Your knuckles are complicated. They are designed to provide flexibility, stability, and strength. Therefore, it is understandable that some complications may arise during and after the recovery process. The most common complication is stiffness. While your knuckle heels, your finger will be stiff.

The worst thing you could do is leave a broken knuckle untreated. If left to heal on its own, your knuckle will heal in an unnatural position that will further minimize flexibility, minimize strength, leave your finger looking deformed, and leave you with pain. If you have a broken knuckle, don’t delay. Make an appointment at Arora Hand Surgery, located in Howell, Macomb, West Bloomfield, and St. Clair Shores, to learn about your treatment options. Contact us today to book your consultation.

Categories
General Wrists

What Can I Expect During Broken Wrist Recovery?

Read Blog

A distal radial fracture, commonly called a broken wrist, affects the larger of the two bones of the forearm close to the wrist. A broken wrist is the most common fracture of the arm and represents 10 percent of total fractures that occur in the United States. This injury typically occurs from falling on an outstretched arm or while biking, skiing, skating, or playing a contact sport.
 
 
When is a Wrist Injury Severe?

The recovery time for a broken wrist depends on the severity of the fracture. Fractures that are more severe will take longer to heal than other breaks. This includes when the break affects the wrist joint, when the bone is broken in more than one place, when the broken bone protrudes through the skin, when the fractured bone moves out of place, or when a ligament, blood vessel, or nerve is torn or injured as a result of the injury.

How is a Wrist Injury Diagnosed?

If you’ve had an injury to the wrist, have it checked out if you are experiencing tenderness, pain, swelling, bruising, or a crooked or bent appearance. Seek emergency medical attention if you are experiencing severe pain, your hand and/or arm is numb, or blood has drained from your fingers. Our doctor will examine your hand and arm as well as take X-rays to determine whether a bone is broken.

How is a Wrist Injury Treated?

Depending on the severity of the fracture, the bone may need to be reset. This can be quite involved and is usually done under anesthesia. Once the broken bone is in the correct position to heal, it will be held in place with a splint after the injury. This gives swelling a chance to resolve before a cast is put on the arm. Regular X-rays will be conducted to make sure the bone is healing correctly.

Your treatment for a broken wrist at Arora Hand Surgery will depend on a multitude of factors. Make an appointment at our office in West Bloomfield, Howell, Macomb, or St. Clair Shores to learn about your treatment options. Contact us today to book your evaluation!

Get on the List

Subscribe

Patient

Stories

Read All

Dr. Aroras office from my first call to schedule my appointment was friendly. Walking in the first day, I felt like I was in a nice atmosphere. Dr. Arora was EXCELLENT in taking great care of my hand injury. He was gentle and very understanding to the concerns I had about my hand. His expertise was admirable and I would recommend anyone with an injury to their hand to his office to be under his care. Because of him, I have healed faster than expected and will make an 100% recovery! Thank you Dr.

Jackie S.

I first thought I was going to have to have painful injections or surgery, but Dr. Arora suggested physical therapy may do the trick. I was doubtful, but I agreed to do it. Now, my pain is gone, and with the help of an ergonomic keyboard at work to keep my hands in the correct position, I am virtually pain free. The therapy strengthened my wrists and shoulders, and built more flexibility into my wrists.

Jerry T.

My experience with this doctor was positive from the outset. Dr. Arora was kind and spent a great deal of time with me. Staff was friendly. The office was nice and bright.

Ariel G.

Very friendly and helpful Great staff!!! Doctor Arora was very professional and did great work. I was very happy with everything!

L B.