Boyd W. Haynes III, MD
In my first article on this subject, we discussed the causes, risk factors and symptoms of Dupuytren’s contracture. In this article, we’re going to delve into how a diagnosis of DP is made and what options are available to patients for treatment.
Diagnosis
Diagnosis of Dupuytren’s contracture is primarily clinical, meaning I will need a thorough patient history and will complete a physical examination, as well as order x-rays to ensure that no structural/mechanical issues are happening concurrently, such as arthritis or bone spurs.
- Since DP typically involves only the hands (but not always!) I will examine them to look for that orange peel appearance I referenced in the first article (pitting, bumpy) and also for the formation of any nodules or cords. I will then assess the level of finger contracture. In the early stages, there may be little.
- I will also see how well the patient can perform certain tasks, like shaking my hand, gripping or range of motion tests. I’ll ask about any difficulties doing everyday activities or work.
- Next, I’ll ask them to place their hand flat on the exam table, a simple yet effective test. Inability to do so indicates Dupuytren’s contracture.
In most cases, I can usually make a diagnosis based on these observations and the physical examination. However, in atypical cases, I could order an ultrasound or MR scan to assess the extent of tissue involvement.
Treatment
Here’s the bad news - there is no cure for Dupuytren’s contracture. The good news is that there are treatment options, both conservative, procedural and surgical, that can help you to manage symptoms and improve hand function. It really will come down to how severe your symptoms are and how badly it impacts your functionality.
Conservative Treatments
Observation: When contracture does not interfere with hand function and DP is in the very early stages, monitoring the condition over time may be all that’s needed. It’s important to track the progression of the condition, however, with your physician.
Physical Therapy
In the early stages of DP, Physical Therapy can play an extremely important role in helping patients keep mobility and range of motion in their affected finger(s). The Physical Therapist can employ a variety of exercises to stretch the hand and fingers, as well as modalities to help to release tension in the restricted area. Manual therapy and massage of the palm have also shown to be helpful.
Corticosteroid Injection
If the nodules in the hand are causing pain, a steroid injection can help reduce inflammation and pain. The injection can also prevent symptoms from becoming worse.
Lifestyle and Home Remedies
- In addition to Physical Therapy, stretching exercises for the fingers done regularly at home can help maintain flexibility
- Patients should guard their hands from injuries and wear gloves for protection when doing yard work, construction projects, etc.
- Patients who have chronic health conditions, such as diabetes, high cholesterol or heart problems should work with their primary care physician to better manage these issues
- Stop smoking and limit alcohol consumption
- Join a DP Support group in-person or on-line
In the next article, I’ll discuss the more involved procedural and surgical treatments for Dupuytren’s Contracture.