Rolling With It

Understanding Dupuytren's Contracture and Its Treatment

Understanding Dupuytren's Contracture and Its Treatment

Dupuytren’s contracture, also called “Viking’s Disease,” is a condition of the hand affecting the underlying palm tissue. It is not the same as Dupuytren’s Disease, which can affect other parts of the body. As Dupuytren’s contracture slowly progresses, the palmar fascia gets thicker and shortens, ultimately forming fibrous cords beneath the skin, constricting the tendons and causing one or more fingers to bend inward toward the palm.

While physicians have identified risk factors for Dupuytren’s, they have not pinpointed the cause of this debilitating condition. Many believe genetics plays a major role. Various treatments are available to ease the condition. In the most severe cases, surgery may be the only option.

The Progression of Dupuytren’s Contracture

This condition often takes years to develop. One of the first signs of Dupuytren’s is a thickening of palm tissue. In time, you may notice puckering or dimples in the thickened tissue. Small knots of eventually form beneath the skin of your palm. These lumps are not especially painful, but they may hurt when pressed. The lumps slowly grow into cords that extend along the palm of your hand and up into the fingers. The ring and pinky fingers are the most often affected. You may lose your grip strength and have trouble holding onto objects.

Risk Factors for Dupuytren’s Contracture

People with Dupuytren’s contracture may share a number of similar habits and traits:

  • Being 40 years of age or older
  • Having a Scandinavian heritage
  • Having other family members with the disease
  • Smoking
  • Drinking alcohol
  • Having diabetes
  • Being a rock climber

Research also confirms that men are more susceptible to the condition than women and that they are more prone to develop severe finger contractures.

Photo Credit: Frank C. Müller

Diagnosis of Viking’s Disease

Doctors often use the tabletop test to help in diagnosing the condition. When you rest your hand facedown on the table, it should lie flat. If there is a space between the table and your palm at least the diameter of a writing pen, your doctor would likely suspect Dupuytren's.

Options in Treatment: Non-invasive

Non-invasive treatment can be effective, especially in the earlier stages of Dupuytren’s contracture. These therapies include:

  • Mild stretching and massage
  • Pharmaceutical therapy
  • Radiation

According to the National Institutes for Health, regular cross-frictional therapy, such as massage, and light finger stretching are effective in increasing the range of motion in the affected fingers.This study also noted reduction in the visibility of palmar adhesions. 

If you learn the correct techniques from your healthcare practitioner, you can regularly massage your hands and do stretching exercises by yourself. A RistRoller® is designed for just this type of use. It is a miniature, affordable version of the foam rollers that physical therapists use to ease sore muscles, massage painful hotspots, and increase circulation.

If you are interested in foam rolling for Dupuytren's Contracture, be sure to ask your healthcare professional how to go about it. Some standard massage therapies involve massaging around the cord, effectively increasing blood flow to the cord and relieving muscle tension, without causing agitation. Other massage therapists actually massage the nodule itself (as was done in the cross-frictional therapy study), as well as all surrounding areas. Be sure to also discuss what density is right for you: soft or firm.

massage stretch rock climbers dupuytren's contracture

 Shown: Foam rolling palms (self-massage)

Photo credit: Dr. Rubina Tahir

A RistRoller® is easy to handle, even if you have contracture in both hands. You can lay the roller on a flat surface and move your palm over it, or you can roll it between both palms.

Pharmaceutical therapy for Dupuytren’s contracture consists mainly of collagenase clostridium histolyticum injections into the cords of the palm.

Radiation therapy works to slow the growth rate of constricting tissue.

Surgical Treatments for Dupuytren’s

Surgical treatments vary from relatively simple outpatient procedures to more invasive inpatient operations. A needle fasciotomy requires only a local anesthetic. The physician inserts a needle through the skin and breaks up the corded tissue, freeing up the constriction so that you gain a wider range of movement in the affected hand. An open fasciotomy is more effective and long lasting in treating severe contracture. It is also an outpatient procedure using local anesthetic. However, the surgeon makes an incision in the palm, opening up the skin to more effectively break up the thickened tissue. A fasciectomy requires general anesthetic. The surgeon cuts and removes the constricting tissue from your palm. This is the most invasive but the most permanent treatment for Dupuytren’s contracture.

Conclusion

Different therapies are likely to be effective in different stages of Dupuytren’s contracture. Massage and stretching are non-invasive techniques that may help throughout all the stages because they provide relief without causing harm. Rist Rollers® help you effectively massage small areas like the palms of your hands, whether they are affected by Dupuytren’s or simply stiff and sore. Ask your healthcare professional about massaging with Rist Roller®

Further Reading on Dupuytren’s:

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