How we test it:
We are experienced in testing the different types of problems that can cause your hand & finger problem. Our specialists use a variety of clinical evaluations to determine the extent of the damage. We develop a certain dexterity to detect a problem and distinguish if the nerves, blood vessels or tendons are involved, before any scans are indicated.
If your test results prove that we suspect that you may have another problem relating to the fascia, we will require further investigation. The first on the list will be a Sonar.
X-rays will be an unnecessary test, as the bones are still normal, and the joints are not influenced. So X-rays will be redundant in this case.
This is a very useful tool to see in detail the extent of the damage, but any skilled hand therapist will be able to diagnose a Dupuytren’s contracture without an expensive MRI. An unnecessary test to be performed.
Sonar (Diagnostic Ultrasound):
A sonar can determine the thickness and degree of abnormality of the palmar fascia. It will show the size and magnitude of the problem. This would be the best way to assess the palmar fascia & a Dupuytren’s Contracture.
Why is this not going away?
The contracture in fascia of the palm of your hand will not resolve or disappear without medical assistance. It involves a complex procedure to get the surrounding structures to move freely. An attempt to resolve this on your own you may end up causing more harm.
What makes Dupuytren’s contracture Worse
Ignoring the problem is one of the worst things you can do. If you are not actively trying to improve the problem, it’ll only get worse in time.
Continuing to try and use the fingers in this bent position. Compensating for the problem does not resolve it – it’s only a temporary solution. Before you know, it may complicate your situation even more, causing nerve entrapment, tendon shortening and decreased blood supply to areas of your hand & finger.
A big problem we see with a Dupuytren’s contracture these days:
Surgery attempts to completely remove the palmar fascia. After a patient has surgery, scar tissue forms. Scar tissue is a dense tissue that looks like a spider web. It helps to close a wound very well, but in some cases it can restrict the normal slide of the tendon, nerve & blood vessels.
This can be quite counterproductive; seeing that this is what caused the loss of movement in your fingers in the first place and leading to a never ending cycle. Consulting a trained therapist is very important to ensure that scar tissue is guided to prevent any restriction on the skin and underlying tendons, nerves & blood vessels.
Waiting too long
When you wait too long before getting treatment the contracture can become stiff, hard & firm leaving the fingers in a permanent bent position. If the contracture progresses too far there can be soft tissue implications that will leave you needing skin grafts and other soft tissue reconstruction when it’s finally surgically released.
This implicaties the length and severity of the rehabilitation process, making it very difficult to regain full use of the hand. Research has shown that if moderate symptoms occur for longer than 6 months the effects of conservative treatment is less successful to regain full function.
OT treatment for Dupuytren’s contracture:
Splinting – Sustaining the hand fascia in a stretched position, is vital to prevent the fingers and palm to bend. A hard splint is used to ensure ideal position.
Exercises – We focus on keeping the muscles and tendon gliding and contracting like it should. Will gradually progress you on a program to challenge the tendons & muscles at different ranges.
Tendon gliding – Getting the tendon free from the obstruction, and the restoring its normal slide through the palm.
Strength training: The tendon will need gradual loading exercises to recondition the tendon.
Sensory retraining – To restore the normal feeling in your fingers, the the nerve is affected.
Oedema management – Reduce swelling in and around the hand and fingers
Ergonomics – Changing or adapting activities, tasks or the environment to reduce the risk of a repetitive strain or injury.
Phases of Rehabilitation & Treatment:
1st Phase: Prevent the Contrature getting worse
Education & assessment of daily activities to determine contributing factors and activities that must be avoided.
2nd Phase: ‘Normal position’
Use of Splinting, loading exercises to regain the normal open hand position.
3rd Phase: Regain normal Finger Range of movement
Allow fingers joints, tendons, & nerves to move independently.
4th Phase: Grip & Muscle Strength
Regain normal grip. Opposition of fingers & forearm flexor muscle strength by grading scale of muscle contraction focussing on eccentric and concentric contractility.
5th Phase: Dexterity & Fine motor skills
Able to perform intricate & delicate actions using the fingers & hand. Retraining the sensitivity & magnitude of contractions performed by the forearm flexor muscle group.
6th Phase: Return to full function & Participation
Able to catch an incoming ball, reflex testing, reaction ball retraining. Fast response & grading of movement pattern.