Chapter 14: Dupuytren’s Disease

Chapter 14: Dupuytren’s Disease

I’m tackling another common upper extremity condition today – Dupuytren’s Disease.

What is Dupuytren’s Disease?

Dupuytren’s is a condition in which the palmar fascia of the hand progressively tightens (Coppard, 2020). Fascia is connective tissue that sits right under the skin. Fascia holds nerves, muscles, and tendons in place. When this tightens, the finger(s) are pulled into a flexed position (pulled in towards the palm).

Risk factors for Dupuytren’s include genetics, diabetes, alcoholism, trauma, & epilepsy (Coppard, 2020). Unfortunately, due to the genetic predisposition of Dupuytren’s, there is a chance the disease will eventually return after surgery.

What does Dupuytren’s Disease “look like”?

Typically, Dupuytren’s affects the ulnar side of the hand (the pinky side); therefore, the pinky and ring fingers are commonly pulled into a flexion contracture (Coppard, 2020). A contracture is a fixed position of a joint(s). In this case, the pinky & rings fingers are unable to extend or straighten. They are essentially “stuck” in a flexed position.

Along with the flexion contracture, nodules often appear at the distal palmar crease (Coppard, 2020). Imagine nodules as permanent tiny little bumps. The distal palmar crease (DPC) can be located by trying to practice palm reading. The DPC is “highest” most crease before reaching the base of the fingers. If you begin to flex your fingers down, this is the first crease you see wrinkled. The nodules may not be painful at first but can most definitely impact the ability to perform daily tasks.

The severity of the contracture will influence the type of treatment provided. Severe contractures (>30 degrees of flexion) often warrant the need for a surgical procedure (Coppard, 2020). Contractures <30 degrees of flexion are typically treated with conservative treatment (Coppard, 2020).

How do OTs help individuals with Dupuytren’s Disease?*

Humans use their hands for basically every task of the day. Next time you pick up your phone to talk to text, try keeping your pinky & ring fingers flexed into your palm. Not so easy, right? Or try typing on your computer using only your thumb, pointer, and middle fingers. Dressing would become more difficult. Reaching into the pocket of your jeans for your wallet or keys may become troublesome. OTs consider all these tasks (and more) when working with an individual with Dupuytren’s. How can we adapt activities in a way to promote independence and successful engagement?

Certified hand therapists (OTR/L, CHT) may frequently work with individuals with Dupuytren’s, especially post-surgery; however, there is a chance that OTs outside of the hand therapy environment may work with an individual with Dupuytren’s.

Conservative treatment may include soft tissue manipulation using Graston (a “knife”-like tool) and functional adaptations (Coppard, 2020). Soft tissue manipulation is completed in hopes of “loosening” the soft tissue that is pulling the fingers into flexion. Functional adaptations are recommended to promote engagement in occupation and to slow the tightening of the fascia over time.

Non-conservative treatment involves surgery. There are multiple surgeries that could be performed. The surgical procedure would depend on the surgeon’s preference, the disease’s severity, and the disease’s location. OTs would be highly involved in the post-surgical process by fabricating an orthosis and recommending exercises to help with healing, educating individuals on tendon glides, and providing treatment for scar management for optimal scar healing (Coppard, 2020). As mentioned previously, there is a high likelihood that Dupuytren’s could return even after surgery; therefore, it is important to optimize healing and educate individuals on ways to slow the progression of Dupuytren’s occurring again.

I hope you learned something from today’s post! Stay tuned for more!

*Note: These examples of OT involvement are strictly my own. Information on this post was provided through the reference referred to below.

Reference: 

Coppard, B.M. (2020). Hand immobilization orthoses. In B.M. Coppard & H.L. Lohman (Eds.), Introduction to orthotics: A clinical reasoning and problem solving approach (5th ed., pp. 187-212). St. Louis, MO: Elsevier.

 

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