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You will need

• - Kerosene
• - Vegetable oil
• - Hot pepper
• - Wool fabric
• - Chestnut fruits
• - Vodka
• - Plaster splint

Instructions

The patient can do the massage independently. It starts from the palmar surface of the forearm. It is necessary to clasp the forearm with your healthy hand in the area of ​​the wrist joint, while the thumb should be on the palm. Using circular movements of your thumb, using moderate pressure, massage the palmar surface of your forearm for 5 minutes.

The opposite side of the forearm should be massaged with four fingers. Apply light circular strokes in the direction from palm to elbow. The duration of the massage is about two minutes.

Massage of the fingers of a diseased hand is carried out with the thumb and index finger of a healthy hand. Using gentle pressure, massage each finger from the nail to its base. Spend about thirty seconds on each finger.

It is welcome if massage is combined with physical therapy. Most of the exercises included in the complex of physical therapy are performed with both hands at the same time.

Place your hands on the table, palms down. Spread your fingers apart and return them to their original position. Perform this exercise more intensely with your sore hand than with your healthy hand. Repeat the exercise ten times.

Place your hands on the table, palms up. Bend your fingers into a fist so that your thumb is on top, then in the reverse order. Repeat the exercise 10-15 times.

Place your hands on the table, palms up. Squeeze your fingers into a pinch. Perform the exercise with all fingers 10-15 times.

Place the affected hand on its edge and raise your thumb up. Bend four fingers and point your thumb back. Do the exercise ten times.

At the very beginning of the disease and after surgery, traditional medicine recipes will be effective, which can be used in the form of rubs, tinctures and compresses.

Take 250 ml. kerosene, the same amount of vegetable oil and ten pods of hot pepper. Pass the pepper through a meat grinder, mix with oil and kerosene. The resulting mixture must be infused for 10 days and then strained. Rub the sore palm with this solution and wrap it with woolen cloth.

Take 400-500 g of pre-peeled chestnut fruits and pour vodka (500 g) for three weeks. After straining the solution, you can rub it on your palm. This recipe is used for pain syndrome.

Splint bandages are often used in treatment to fix the fingers. The splint is placed from the middle of the forearm to the very tips of the fingers, thus fixing them in the extension position. The splint is usually used at night.

They are among the most common diseases in recent times. A common condition is contracture, when bending a joint is very painful or completely impossible. One of the varieties is Dupuytren's contracture. Treatment with folk remedies (reviews about it are mostly positive) helps to cope with the disease if it is not advanced.

Dupuytren's contracture

The disease is expressed by excessive growth of tendon tissue and their deformation, as a result of which the fingers are fixed in a bent position and their extension is limited, which leads to partial or complete immobility. This can lead to loss of basic hand function. The process is localized in the palm of the hand. In the area of ​​the damaged tendon, a compaction develops in the form of a leathery nodule. The tendons of the ring and little fingers on the right hand are most often affected.

The disease got its name from the French doctor who described in detail the clinical picture of this disease. The disease most often occurs in men in adulthood, but in women it occurs 10 times less often. At an early stage, it is quite possible to use folk remedies. But with the progressive course of the disease, most often it is impossible to do without surgical intervention.

Stages

Considering the symptoms, 4 stages of Dupuytren's contracture can be distinguished:

1. The formation of a small nodule or compaction on the palm measuring from 0.5 to 1 cm, which does not interfere with everyday life. Only sometimes pain is possible upon palpation.

2. The cord increases in size, spreading to the underlying skin in this place, it becomes rougher, folds and funnel-shaped depressions appear on it. The extension function is limited, but not significantly, therefore, with timely diagnosis of a disease such as Dupuytren's contracture, treatment without surgery can still give a positive result.

3. The process spreads in such a way that the extension deficit can reach 90 degrees. To bring the finger into a fully extended position, a palmar capsulotomy is often required. To fully restore finger extension, surgery is necessary.

4. The pathological process involves the tendon apparatus and articular structures. Dupuytren's contracture may eventually lead to inflexion of the affected finger. Surgery at this stage does not always give a positive result. In some cases it comes to amputation.

Symptoms

The clinical picture has its own characteristics. The appearance of a dense nodule in the palm of the hand in the area of ​​the metacarpophalangeal joint, along with limited ability to straighten the finger, is the main sign of the disease. A gradual increase in size of this compaction leads to shortening of the tendon and the formation of contracture in the interphalangeal joint.

Funnel-shaped depressions and bulges are clearly visible in the affected area. There is practically no pain in the first stages of the disease. No more than 10% of patients diagnosed with Dupuytren's contracture complain about them. Photos of pronounced signs of the disease demonstrate that it is quite difficult to confuse them with the symptoms of any other diseases.

Diagnostics

Often, patients consult a doctor when the disease is advanced and functions are already impaired. Even at the earliest stages, the diagnosis is determined by the characteristic clinical picture by palpation, determining the degree of finger mobility, and assessing the range of motion of the joint (without the use of any laboratory tests). A timely diagnosis of Dupuytren's contracture is of great importance. Treatment without surgery using conservative methods in this case can have a positive effect.

Causes

Most scientists believe that the main cause of the disease lies in hereditary inferiority of connective tissue, as well as in insufficient restoration of adenosine triphosphoric acid. The disease can be provoked by a number of factors: age-related problems (arthritis, arthrosis), chronic injuries to the surface of the palm associated with difficult working conditions, bad habits, lack of blood circulation. All this contributes to the development of the disease Dupuytren's contracture. There may be other reasons, for example, diabetes mellitus, kidney disease, nervous system disease, epilepsy.

Movement therapy. Reviews from doctors

One of the most effective methods of treatment and prevention, according to doctors, is therapeutic exercises. Properly selected movements cause increased nutrition in the periarticular tissues, contribute to the normalization of metabolism, thereby reducing the risk of Dupuytren's contracture. Gymnastics includes an exercise such as extension exercises, when, using a healthy hand, the patient works out the fingers of the affected hand, smoothly extending them in combination with stroking movements on the forearm.

Among active exercises, as doctors note, exercises using exercise machines are the most effective. They can be purchased at any sports store. These are special balls for the hand, spring or By using them for a month for 15-20 minutes daily, you can significantly increase the strength of stretched muscles.

According to experts, only with perseverance and perseverance can such an ailment as Dupuytren's contracture be overcome. Treatment with folk remedies has good reviews, but it will be effective only when it is supplemented with simple exercises to develop the muscles of the hands. They are aimed at stretching shortened and strengthening weakened muscles. An integrated approach, including one, is very important for this disease.
If you have the opportunity to visit a physiotherapy office, you should not miss it either.

Folk remedies. Reviews

Widely used by people who have Dupuytren's contracture, treatment with folk remedies. Reviews of the use of various home techniques confirm that with their help you can significantly slow down or even stop the progression of the disease. Patients use ointments and rubs prepared independently every evening.

Treatment of a disease with folk remedies requires maximum care, so you need to set aside time for it. The effectiveness of traditional medicine recipes, as noted by patients, is especially high in the early stages of the disease, as well as in the postoperative period. The main methods of combating the disease are the use of rubbing, baths, and compresses.

The most popular is a bath with peelings of potatoes, carrots, onions and beets. Place the peelings in a large saucepan, pour water and add a spoonful of salt and 20 drops of iodine tincture (per 5 liters of peelings). Cook the whole mass until the vegetables soften, then cool to a temperature of 40 degrees and lower the sore hand into it for 10 minutes, trying to straighten the fingers. After finishing the procedure, wrap the brush with a warm towel.

Application of massage and compresses

Massage with butter, as patients testify, also helps get rid of such ailments as Dupuytren's contracture. Cover your hands with oil (preferably homemade), then stroke them for 6 minutes, thoroughly rub your fingers and palms until tolerable pain appears.

You can use aloe juice for compresses. Mash the thick leaf, lubricate the sore spot and leave for a few minutes, then wash your hands with warm water. Using a decoction of pine needles or cones as a lotion is very effective. Pour 100 grams of pine needles with a glass of boiling water and let it brew. Apply a tampon soaked in this broth to the sore arm for a while. The condition is greatly facilitated by the rubbing procedure using ointments prepared according to special recipes.

Oral preparations

Chestnut tincture, which is used for internal use, has a lot of positive reviews. The flowers of this plant should be infused in vodka (one handful of flowers per 500 ml of vodka) for two weeks in a dark place, then strain and drink 30 drops 4 times a day.

A good effect, according to patients, with long-term use (at least a year) is achieved by oat infusion. Pour a glass of grains with a liter of water and leave for 10 hours. After this, boil, let it settle, add water to the original volume and take 100 ml 3 times a day for 1.5 months. Then there is a month break and the course is repeated.

When Dupuytren's contracture is in its initial stages, treatment without surgery should be accompanied by a change in diet. You should exclude dairy products, flour products, sweets and increase the consumption of seafood, white cabbage, carrots, horseradish, radishes and onions.

Rub recipes

Numerous reviews from patients with contracture who used rubs for treatment include recommendations for their preparation. In folk medicine, there are quite a large number of remedies that are easy to prepare at home.

• Mix 250 ml of kerosene, the same amount of vegetable oil and 7-10 pods of hot pepper, minced and leave for 9 days. Then strain and rub the resulting mixture with stroking movements into the sore spots.
• Infuse 300 g of crushed chestnut fruits in vodka (500 ml) for 2 weeks, then strain and lubricate your hands before going to bed.
• Pour 500 g of finely chopped horse chestnut into a dark glass bottle, add water and leave for 14 days. Rub the resulting infusion into the sore spot before bed.

The effective effects of a healing ointment prepared from oil and beeswax have been experienced by many patients who have been treated with folk remedies when diagnosed with Dupuytren's contracture. Their reviews indicate that this ointment perfectly relieves inflammation and itching, softens the skin and smoothes out scars in the area damaged by the disease.

To prepare, boil 250 g of butter and 100 g of beeswax, then add 100 g (in powder form) and boil for another 10 minutes, add 30 g of celandine powder, boil for 5 minutes, pour in 0.5 liters of St. John's wort oil, bring to a boil and filter. Place the resulting ointment into jars with lids and use for rubbing.

Regardless of what ointment is used for rubbing, be sure to wrap the sore hand with a warm scarf or blanket after the procedure.

Disease prevention

It is easier to prevent any disease than to treat it. And Dupuytren's contracture is no exception. For the purpose of prevention, you should definitely use a softening hand cream and gloves made of thick fabric when working with metal, since any appearance of cracks in the skin can contribute to the onset of the disease. If the work requires keeping your hands in a bent position for a long time, then every hour you should do a 5-minute warm-up, bending and straightening your fingers.

Therapy will be difficult if a diagnosis of Dupuytren's contracture is made. Treatment without surgery usually only helps to stop the disease, but even surgery does not always get rid of it. Therefore, it is worth paying great attention to prevention, especially for people with a hereditary predisposition.

Under no circumstances should you self-medicate. Regarding the use of any folk remedies, you should definitely consult your doctor. He will determine the stage of the disease and give recommendations on how to treat Dupuytren's contracture at home.

Read about treatment without surgery for Dupuytren's contracture. About 3% of the world's population suffers from this pathology. More often it occurs in able-bodied men after 40 years of age; the hands become deformed and lose their functions.

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The site provides reference information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor. Any drugs have contraindications. Consultation with a specialist is required, as well as detailed study of the instructions! .

Modern treatment without surgery

Despite the seriousness of the disease, Dupuytren's contracture can be treated with conservative treatment methods.

To achieve this, various procedures are carried out that can relieve pain and ensure the restoration of normal limb functions.

When prescribing treatment measures, the following are taken into account:

• Reason for appearance;
• Location of scars;
• The degree of tissue damage;
• Patient's age.

Here is a list of treatment procedures to alleviate the condition of patients and accelerate the restoration of joint function:

• Treatment with painkillers, hormones, NSAIDs;
• Therapeutic blockades with the introduction of drugs into the joint cavity in the area of ​​​​the nodes in the palm;
• Manual therapeutic procedures for joints and muscles, UHF, therapeutic exercises and types of massage with elements of self-massage.

Drug therapy includes:

• Glucocorticosteroids in the form of injections into the area of ​​the node, drugs - diprospan, dexamethasone, kenalog, which help reduce pain;
• Xiaflexa is a combined drug, administered by injection, which has a destructive effect on collagen;
• Applications with lidase, trypsin, rodinase to the affected areas, they help slow down tissue degeneration, soften the peri-scar tissue, and relieve tension in the hand.

Physiotherapy procedures using mud and paraffin baths, electrophoresis, and phonophoresis for the hands help simultaneously warm up problem areas and provide a mineral “feed” for the sore joint.

All these procedures are effective at the initial stage of contracture development.

What is the disease

Dupuytren's contracture is named after the French doctor who described the clinical picture of the disease at the beginning of the 19th century. It is otherwise called palmar fibromatosis.

With this disease, the tissue of the tendon of the palmar aponeurosis degenerates, gradually shortens, turning into a scar in the form of a tourniquet.

The palmar aponeurosis occurs in the form of a triangular plate, located under the skin of the palm. Benign compaction of the aponeurosis takes a long time to develop, in some patients it even takes up to 8 years.

At first, patients mistake pathological nodes for calluses. The seal limits the extension of one or more fingers, usually the little and ring fingers.

Subsequently, they curl up and remain in this position. Although the disease is not fatal, able-bodied men engaged in physical labor suffer due to dysfunction of the hand.

Causes of contracture

Scientists do not have the same opinions about the mechanism of the appearance and development of this insidious disease.

The possibility that heredity plays a role is supported by the fact that all family members who suffer from palmar fibromatosis were found to have a gene that was absent in healthy people.

But not everyone who has this gene develops the disease. The onset of the disease probably requires that the body be exposed to some risk factors.


Based on the research of scientists and the observations of doctors based on the anamnesis of patients, we can conclude that the risk factors are:

• Professions that involve heavy manual work (loaders, porters, long-haul drivers, mechanics, carpenters, etc.);

• Arm injuries and hand injuries that caused tendon strain;
• Smoking, alcohol abuse;
• Gender and age, most people get sick after 40 years of age;
• The presence of kidney and liver diseases, diabetes, epilepsy, which cause disorders in connective tissues.

If the disease is detected in the early stages of development, you can get rid of it using conservative treatment methods:

• Medicines;
• Massage;
• Physiotherapy;
• Therapeutic exercise.

Along with these treatment methods, traditional medicine can be used.

How does this pathology manifest itself?

Dupuytren's contracture is a relapsing chronic disease. The connective tissue of the palmar aponeurosis under the skin during contracture degenerates into fibrous tissue, forming dense scars.

Scars gradually cause damage to the joint capsules and tendons. The skin becomes lumpy due to nodules underneath.

There are 3 known types of such lesions:

• Palmar;
• Finger;
• Mixed.

During the first stage, lumps in the form of nodules appear under the skin in the palm area, which are initially mistaken for calluses. No one suspects the onset of the disease, because the fingers move and there is no pain. Sometimes you feel pain when you touch it.

The second stage is accompanied by the following signs: the seals will be rougher, depressions like a funnel and retracted folds will appear on the palm. Extension movements of the hand will be limited by about 30 degrees, the patient’s finger will not bend.

Characteristic signs of the third stage of the development of the disease are the following symptoms: the fingers are involved in the process, the movement of which becomes limited by 30-90 degrees.

The sore finger does not straighten and is constantly in a bent position. The patient feels pain in the hand. The function of the affected arm is impaired.

The fourth stage is characterized by more pronounced pathological changes.

Joints and tendons are involved in the process, they contract even more, and strands appear on the palm of the hand.

The affected fingers almost do not straighten and are in a position of more than 90 degrees to the palm. The brush loses its functions and becomes deformed.

In some cases, as the nodule enlarges, connective tissue grows. It begins to compress the blood vessels and nerve bundles, and then it is necessary to amputate the finger.

Sometimes they form a fixed joint, as a result of which the fingers cannot bend at all.

Video

Effective ointments

When carrying out complex treatment of contracture, ointments and medicinal gels are used to relieve pain and relieve tissue swelling. Scars under the influence of ointments will be soft and the skin will be elastic.

Patients note effectiveness after using such ointments.

1. Contractubex, it has the ability to slow down the formation of scar tissue and stimulates the production of collagen.
2. Kelofibrase - a cream that softens scars, well maintains the water balance in the skin. Used against inflammatory processes and to prevent stretch marks after operations.
3. Kelo-cote silicone gel from an American company, which helps in the treatment of various scars after surgery.
4. Fermenkol, which is used both before surgery and after open type contracture surgery, after needle aponeurotomy. Effective together with electrophoresis and phonophoresis in the recovery stage.
5. Dermatix - used after surgical operations after wound healing.

We cope at home with folk methods

Traditional medicine has many means for treating “chicken's feet” (as contracture is popularly called) at home.

They can stop further progression of the disease in the initial stages of development.

To treat Dupuytren's contracture at home, use:

• Compresses;
• Rubbing with ointments;
• Baths with decoctions.

Options for preparing a healing ointment

A healing ointment that is prepared by mixing fresh butter with beeswax is effective. It softens scars and rough skin on the palm, relieves irritation, itching and inflammation.

To prepare it, mix 250 g of butter with 100 g of beeswax and 100 g of pine resin. The mixture is boiled for 10 minutes, adding dry celandine 30 g, boiled for another 5 minutes, half a liter of St. John's wort oil is poured into it. After bringing to a boil, remove from heat, cool and filter.

Help from home medicinal baths

Use baths with vegetable peelings. To do this, place peelings of beets, potatoes, onions and carrots in a bowl, pour in water and add a spoonful of salt with 20 drops of iodine (calculated for 5 liters of water). The whole mass must be cooked until the vegetables soften.

After the broth has cooled to body temperature, the sore hand is lowered into it and held for 10 minutes, making movements to straighten the fingers. After taking a bath, wrap your hand in a warm soft towel.

Conducting effective massage sessions

Patients respond well to massage using butter. Apply fresh butter to the affected hand, then make stroking movements for about 5-6 minutes, rubbing the palms and fingers until mild, tolerable pain appears.

You can use aloe juice. For this purpose, a dense, freshly picked leaf is suitable, which should be thoroughly mashed until juice is obtained. Lubricate the hands of sore hands with the juice that appears and hold for several minutes.

Useful gadgets in the fight against a running process

Healers offer lotions with an infusion of pine or spruce needles with the addition of their cones. Prepare an infusion of 100 g of pine needles in a glass of hot water. A cloth soaked in the infusion is applied to problem areas of the hand.

A glass of kerosene is mixed with a glass of vegetable oil with the addition of 7-10 pods of hot pepper, passed through a meat grinder. The infusion will be ready in about 10 days. After filtering, it is rubbed into the affected areas with gentle stroking movements.

Tincture of crushed chestnut fruits 300 g in alcohol (0.5 l) also helps well with contracture. Ready in 2 weeks. Before going to bed, lubricate your hands with the resulting tincture.

The need for surgery

There are several methods of surgical treatment. When the disease reaches stage 3 of development, at which the contracture of the finger acquires an angle of more than 30°, this indicates that surgical intervention is necessary. Although some doctors suggest surgery at stage II.


In our country, the segmental excision method is used during surgery for Dupuytren's contracture. It is considered a more correct technique when only the affected area of ​​the aponeurosis is removed from the base of the palm to the place where it is attached to the finger.

When deciding on surgery, the patient's age and disease progression are taken into account. When a contracture is removed, the affected tissue is excised so that movement in the joint can be restored later.

The aponeurotomy procedure is performed under general anesthesia or local anesthesia. After excision of the tissue, the surgeon sutures the wound, then a tight sterile bandage is applied to the palm.

The finger is fixed with a functional splint in the position in which a healthy finger is usually found. The bandage is not removed from several weeks to several months, it all depends on the nature of the disease.

In severe cases, another surgical method is used, which is called arthrodesis. During arthrodesis surgery, the finger that is unable to move is fixed in the most advantageous comfortable position. It will not be able to move like a healthy finger, but it will not interfere with the sick one.

Medical equipment with strong optics has appeared in clinics; after microsurgical operations to remove contractures, complications are not observed.

They began to use needle aponeurotomy, in which the seals under the skin are pierced with an injection needle in different directions.

The fibers of the cord are damaged, the functions of the finger and hand are restored. The operation requires a lot of experience from the surgeon, because the nerves and tendons of the hand can be affected.

Rehabilitation in the postoperative period

When using needle aponeurotomy, rehabilitation measures can begin within a few hours; this method does not leave wounds or stitches. It is necessary to begin developing the hand with flexion and extension.


When performing an open operation, rehabilitation should begin after the sutures are removed:

1. After the operation, you need to monitor the joints that are not in plaster so that they are in motion, but in moderation.
2. On the first day after surgery, soft tissues and plaster are checked, and on the second and third postoperative days, the Redon drainage is removed.
3. On days 5-7 after surgery, the plaster splint is removed and the bandage is changed.
4. Patients should begin daily physical therapy.
5. 2 weeks after the operation, the sutures are removed and the bandage is changed.
6. Once the stitches are removed, the bandage is no longer needed.
7. They begin to carry out regular (3-4 times a day) exercises with brushes in cold water (you can even add ice). Cold helps relieve swelling and pain. Those who cannot stand the cold can exercise in warm water.
8. 5 days after removal of the sutures, treatment of the postoperative scar begins.
9. Rub various ointments, for example, calendula ointment, several times a day. The scar softens, it becomes elastic, pain and sensitivity decrease.
10. You can pat the scar with a soft brush.
11. The entire period of patient's disability lasts approximately 4-6 weeks.

Rehabilitation must be continued with therapeutic procedures using gymnastics.

Physical therapy for the patient

Performing physical exercises is considered one of the effective ways to eliminate contracture; muscles contract, joints move, and there is an increased supply of nutrients to the connective tissues of the body.

During physical therapy procedures, extension movements are performed, the muscles of the hand are stretched and act against the tightening of the ligaments of the hand and fingers.

Using your healthy hand, you can work out the bent fingers of the affected hand, carefully straightening them and bending them until a slight pain appears.

Here are some simple exercises:

1. Snap the brush with each finger several times.
2. Squeeze all 5 fingers into a pinch 10 times. Hands are on the table, palms up.
3. Perform scratching movements on the surface of the table with your fingers, which are palms down.
4. Develops the hands by bending and straightening the fingers lying on the table.
5. Spread your fingers, hands lie palms down, return to the starting position. Repeat 10 times.

Exercises using a power expander give good results. For contracture, strength kinesitherapy is used, which is a synthesis of physical therapy and sports training.

Muscles with contracture are “dragged” into the pathology process.

And the work of the muscles can be controlled by both the doctor and the patient himself, giving the muscles a feasible load.

Therapeutic exercises can be done during the rehabilitation period and to prevent the disease. For example, it is easy to perform exercises to bend and straighten your fingers for 5-6 minutes until a burning sensation and compression appear.

With regular exercise, further progression of contracture can be prevented.

4.2 / 5 ( 8 votes)

Dupuytren's contracture is quite common in traumatology and orthopedic practice. The disease affects men aged 35-50 years, with bilateral lesions detected in 50% of cases. In women, it is diagnosed 10 times less often and is much easier to tolerate. At the initial stage of development of Dupuytren's contracture, conservative treatment is carried out. For severe tendon damage, patients are advised to undergo surgery.

What is Dupuytren's contracture?

Dupuytren's contracture is a non-inflammatory pathology that affects the tendons of the palms. Due to their shortening, the functioning of the entire hand is disrupted. A person has difficulty performing previously familiar movements - grasping and holding an object with his hand, resting on any surface.

The pathology tends to progress slowly in middle and old age. And in young patients, there is a significantly faster development of Dupuytren’s contracture, its spread to healthy tendons.

According to statistics, the ring finger is most often affected, followed by the middle and little fingers. The tendons of the thumb and index finger are very rarely affected.

Causes and mechanism of development of pathology

Areas of inelastic, dense fibrous tissue form in the palmar tendons. Since they are deprived of any functional activity, the work of the entire hand is disrupted. If the patient does not seek medical help at the first signs of pathology, the connective tissue cords are shortened. Stiffness of one or more fingers occurs. The situation is aggravated by the appearance of flexion, which limits the range of passive movements.

The reasons for the development of the disease have not been established. Previously, versions were put forward that tendon damage could be caused by diabetes mellitus and metabolic disorders, but so far they have not been confirmed.

There are also assumptions about the following causes of non-inflammatory tendon damage:

• previous injuries - fractures, ruptures of muscles, ligaments, tendons;
• a hereditary structural feature of a wide tendon plate formed from dense collagen and elastic fibers;
• damage to peripheral nerves.

The most plausible version is considered to be a genetic predisposition to the development of Dupuytren's contracture. In more than a third of patients, immediate relatives suffered from this pathology.

Symptoms and signs of the disease

The clinical picture of Dupuytren's contracture is very specific. First, a small rounded lump is formed on the palm, consisting of one or more subcutaneous strands. It gradually increases in size, limiting the mobility of the finger. Then cords appear that extend to the phalanges. The tendon slowly shortens, causing contracture at the metacarpophalangeal joint. Soon the finger ceases to fully bend at the proximal interphalangeal joint.

The skin around the node thickens, becomes rough, and begins to fuse with nearby soft tissues. Lumps and small depressions appear on the affected area. When the tissue is extended, the cords are clearly visible on the surface of the palm. Dupuytren's contracture occurs in only 10% of patients. They are not clearly localized, but spread throughout the entire arm, sometimes radiating.

Which doctor treats

If one or several fingers begin to bend with difficulty, then you need to make an appointment with a traumatologist or orthopedist. It would not be a mistake to contact a general practitioner - a therapist. He will examine the patient and conduct a series of functional tests. After studying them, the patient will be referred to doctors of a more narrow specialization.

Diagnostic principles

The basis for making a diagnosis are the patient’s complaints, medical history, and external examination. The doctor evaluates range of motion, tendon reflexes, sensitivity, and muscle strength. If necessary, he prescribes additional instrumental and laboratory tests, but this occurs extremely rarely.

Damage to the right hand.

General rules and methods of treating Dupuytren's contracture

When choosing a treatment method, the doctor takes into account the degree of damage to the tendons of the palms, the speed of spread of the pathology to healthy tissue, and the severity of symptoms. At the initial stage of the disease, medications are used and physical procedures are performed. But, as a rule, they only slow down the progression of the disease, stopping it for a while. In rare cases, it is possible to reduce the size of the seals and subcutaneous cords.

Conservative treatment

In the treatment of Dupuytren's contracture, physiotherapy and UHF therapy are actively used. The most effective applications are with ozokerite or paraffin, which provide long-term heating of the tendons. Patients are recommended to wear rigid plastic orthoses or removable ones. They are usually put on before going to bed and taken off in the morning.

Surgery

There are no clear recommendations at what stage of development of Dupuytren's contracture should one abandon conservative treatment and undergo surgery. Usually the indication for it is the presence of flexion contracture at an angle of more than 30 degrees. The main objectives of surgical therapy are excision of degenerated tissue and elimination of stiffness.

Selective fasciectomy

Surgery is performed under general or local anesthesia. After applying a special tourniquet, the doctor makes an incision and excises the scarred areas of the tendons. All the surgeon’s movements are precise and clear. This reduces the likelihood of damaging a large number of blood vessels and nerves. The surgeon removes the sutures after 10 days, but the patient can perform active finger movements immediately after the operation.

Selective fasciectomy without general anesthesia

This operation is performed under local anesthesia and lasts from 30 to 45 minutes. Before the intervention, patients regularly perform exercises with a certain range of motion to strengthen the skeletal muscles of the hand. When performing a selective fasciectomy, the doctor takes this information into account and does not use a tourniquet. After excision of fibrous cords and nodes, the surgeon applies a special bandage to prevent the formation of hematomas.

Dermofasciectomy

Dermofasciectomy is indicated for patients with recurrent Dupuytren's contracture or a high likelihood of repeated tissue degeneration. During the operation, the surgeon excises fibrous areas of the tendons and skin. He then installs an autograft taken from the crook of the elbow or the inner surface of the shoulder. After sewing the flap of skin, a bandage is applied to the palm, and the hand is secured with a scarf.

Segmental fasciectomy

When performing a segmental fasciectomy under regional anesthesia, the surgeon excises sections of the shortened connective tissue cord. Removal of fibrous tissue by this method is carried out to completely limit movements in the finger joints. They are fixed in a functionally advantageous position. Segmental fasciectomy is minimally invasive, since it does not require removal of all changed tissue.

Minimally invasive interventions

A minimally invasive method often used in the surgical treatment of Dupuytren's contracture is percutaneous needle fasciotomy. The doctor divides the cord into many segments with a thin needle. After the procedure, it breaks into pieces when the fingers are pulled forward. The advantages of needle fasciotomy are the absence of incisions and the use of local anesthesia. The duration of rehabilitation is only a day, and then the patient returns to an active lifestyle.

Physiotherapy

Daily therapeutic exercises are prescribed to patients during conservative treatment of Dupuytren's contracture, before and after surgical interventions. Regular training helps strengthen muscles and improve blood circulation, increasing range of motion in the fingers. What exercises are most therapeutically effective:

• alternate flexion and extension of fingers;
• clenching and unclenching fists;
• imitation of playing the piano;
• gathering fingers into a pinch and grasping small objects;
• holding a hardcover book in the palm of your hand.

Treatment with folk remedies

Folk remedies in the treatment of Dupuytren's contracture are ineffective. They do not contain ingredients that can inhibit fibrotic degeneration of tendons. And in some cases, they distort the effect of pharmacological drugs, reducing their therapeutic effectiveness.

Consequences and complications

If the pathological process is severe, then the dorsal surface of the proximal interphalangeal joints is modified. Dense nodular growths form on it. There have been cases of formation of tubercles in the area of ​​the wrist joint. In the absence of medical intervention, persistent flexion contractures of the fingers occur. A person loses the ability to perform professional duties and take care of himself in everyday life.

Forecast

Dupuytren's contracture is a frequently recurrent pathology. Repeated tendon damage usually occurs after a few years. This likelihood is much higher in patients with Dupuytren's diathesis (predisposition).

Prevention

Since the reasons for the development of Dupuytren's contracture have not yet been established, no measures have been developed to prevent it. Orthopedists and traumatologists recommend stopping smoking, drinking alcohol, and eliminating increased stress on the hands.

They belong to the group of the most common clinical pathologies. It is often possible to encounter such a joint disease when flexion and extension of the fingers causes painful discomfort, and sometimes is completely impossible.

In medicine, this pathology is defined as Dupuytren's contracture. Treatment without surgery for joint disease is possible only at the initial stage of the disease, when the first signs of joint pathology appear.

Description of the disease

Contracture, translated from Latin, means narrowing or tightening, that is, a condition when a joint cannot fully perform a passive action, bend or straighten.

There is a non-inflammatory process when cicatricial degeneration of the palmar tendons occurs, medically defined as palmar fibromatosis, or Dupuytren's contracture, named after the French military surgeon Guillaume Dupuytren (1777-1835).

It was he, the life surgeon of Louis XVIII, who first described in detail the method of surgical treatment (aponeurotomy) of this proliferative disease of the connective tissues of the joints.

The cause of joint contracture is not fully understood. According to the study, men after 45-50 years of age are most often susceptible to palmar fibromatosis. This disease is rare in women. The most affected area is the ring finger of the hand.

If the pathology is not stopped in time, then a “chain reaction” is possible, involving the middle finger and then the little finger in the affected area. Dupuytren's contracture does not affect the thumb and index finger.

There are several versions of the origin of this disease, which do not have sufficient argumentation, since practically no one in the world really deals with this problem.

Guillaume Dupuytren himself, describing the disease, believed that “contracture develops as a result of prolonged compression of the fulcrum in the hand.” Limitation of flexion or extension of a particular joint is caused by mechanical injury to the fingers. Due to damage to connective tissues, insufficient nutrition occurs, which creates conditions for degenerative-dystrophic dysfunction. Opponents of G. Dupuytren’s theory believe that neurogenic transformations in connective tissues caused by pathology in the periphery of the nervous system, in particular, ulnar nerve neuritis, are to blame.

Other medical experts are inclined to believe that the cause-and-effect relationship for the development of palmar fibromatosis is.

However, the most popular version remains the opinion about the tumor-like nature of Dupuytren's contracture, associated with the development of the expressive oncogene C-myc in the cellular structure. A hereditary form of the disease cannot be excluded.

Signs and symptoms of Dupuytren's contracture

The initial stage of fibromatosis of the palm begins with a nodular compaction on the pad under the main phalanx of the affected finger. The tubercle may initially cause pain or not cause much discomfort, manifesting itself as periodic itching in the affected area.

As the disease progresses, the range of motor activity of the affected finger becomes limited. The development of Dupuytren's contracture is divided into three stages, or phases, of the joint disease.

It is easy to test and make a preliminary diagnosis. If you find a suspicious bump on your ring finger, you must place your palm on a flat, smooth surface, such as a table, and if a pencil or ballpoint pen passes freely through the space between the table and the bend of the main and middle phalanx, it’s time to consult a doctor.

As a test, you can check how quickly and painlessly your fingers bend and straighten.

The first sign of contracture is wrinkling of the skin of the palm.

How to treat contracture

With fully developed Dupuytren's disease (contracture) treatment without surgery is impossible. Limitation of joint mobility of a finger significantly affects a person’s quality of life. It becomes problematic to perform simple actions when you need to firmly grasp an object with your palm.

A calming factor is the slow progression of the disease. It is human inaction that leads to severe disease, when surgical intervention is required. The final formation of contracture does not occur suddenly or immediately. The disease can be recognized in the initial phase of clinical pathology.

Surgical correction is still inevitable, but when it will be carried out depends on the person himself. For some, aponeurotomy is performed after 1.5-2 years, when the contracture of the bend of the finger reaches an angle of 30º, while for others this procedure may occur in old age.

Non-surgical methods

Conservative therapy at the initial stage of the disease involves physical treatment with thermal procedures (electrophoresis, heating with paraffin), high-frequency electron beam radiation (UHF) and special therapeutic exercises for the fingers, aimed at stretching the palmar aponeurosis.

The patient will be offered the use of a corrective splint, which will fix the finger in the extension position. This orthopedic device is worn at night and removed in the morning.

Therapeutic blockades are very effective in preventing cicatricial contractions. Among the most effective drugs:

• Diprospan® from the commercial manufacturer of the Belgian company SCHERING-PLOUGH LABO N.V.;
• Hydrocortisone® is produced by the chemical and pharmaceutical plant AKRIKHIN JSC (Russia).

These medications are mixed with and injected into the painful node. The effect of this treatment lasts no more than 1.5-2 months, then the procedure is repeated.

The use of the enzyme preparation collagenase Clostridium histolyticum®, which, by injection into nodular formations, promotes the active breakdown of the protein structure, has found widespread use in the non-surgical treatment of Dupuytren's contracture.

American scientists have found that the rate of recurrence of the disease is about 60% after using the collagenase enzyme. The deterioration of the situation in such patients was recorded only after four years of observation.

Conservative treatment does not affect the reversibility of the processes, but only slows down the rate of development of Dupuytren's contracture.

You can support drug therapy with the help of alternative treatment with folk remedies.

Help from traditional medicine

At the debut stage of the development of the disease, you can and should try to treat: with rubbing, heating, compression applications, baths and herbal infusions:

• aloe treatment. To prepare a homemade medicine, you will need the juice of a young plant, after collecting it, you can begin to lubricate the affected finger;
• for rubbing a sore finger, a product prepared on the basis is very effective. For 100 g of peeled plant product, take 200 ml of vodka or diluted alcohol. The composition is infused for 3 days, then applied to the diseased surface;
• Red pepper, kerosene and sunflower oil will help give elasticity to the affected area. Medium-sized hot red pepper is crushed into small fractions and mixed with two parts kerosene and one part sunflower oil. The healing mixture is infused for no more than 12 hours. Using a gauze pad, the medicine is rubbed into the sore spot with light massaging movements. This remedy can be used in the absence of an allergic reaction to medicinal ingredients;
• A compress made from boiled potatoes is beneficial for the joint. It is necessary to mash the potatoes boiled in their jackets, and after cooling to an acceptable temperature, apply them to the sore spot;
• Therapeutic baths made from pine buds are effective and harmless.

Despite the fact that the disease will continue to progress, hand exercises should be performed daily.

It is very effective to use a shoulder expander to not only pump up the shoulder muscles, but also, by firmly holding the handles of the gymnastic apparatus, to additionally warm up problematic arm joints.

A hand spring or rubber expander helps with Dupuytren's structure: you can not only strengthen your hands and improve blood supply, but also keep the ligaments and tendons of your fingers in good shape.

To slow down the progression of the disease, folk remedies, physiotherapy and gymnastic exercises will not be enough. It is necessary to reconsider your working conditions and the quality of food. To do this, you need to reduce physical stress on your hands and eliminate the consumption of certain foods, for example:

• table salt;
• refined sugar;
• cereal and legume products;
• smoked and fatty foods;
• fermented marinades.

It is necessary to monitor your water balance. Water consumption should not be lower than 2 liters per day, this also includes other liquids, soups, milk, juices.

To properly balance your diet, you need to consult a nutritionist.

Prevention