The case of my right hand - Dupuytren's contracture


1. Injury and rehabilitation


In mid February 2013 I stumbled on a street and the radius of my right hand broke, but not the ulna. For first-aid, I went to the same hospital where my fingers were operated in 2010. 

The first plaster cast didn’t fit very well, my fingers tended to stay bent and if I wanted to extend them, I needed to help with the other hand.

The radius was fragmented and it was operated 9 days later, and the plaster cast was taken away 15 days later. This time I didn’t get a new cast; instead I got a wrist support I could take away when I exercised the hand. 

After the first week I used it only during the night and when I went out. Because the first model caused pain in my hand, I changed the wrist support after one week. 

I used the wrist support until mid April 2013, when I met the hand surgeon for the third time and had a X-ray.

The rehabilitation schedule was the following:


Wrist

This time my wrist was much less stiff and two months after the operation, the flexibility was good, because I could start the mobilization earlier and exercised also in a swimming pool.

In mid May 2013 the fingers bent slightly

However, I had some problems with my fingers and the major knuckles:

Fingers

When I used the wrist support, I felt sometimes cramps or pulling sensation in my right hand and my fingers started to bend slightly, but they straightened with straightening stretch and bend/extend stretch, in 2 months. I didn’t use any finger splints.

Major knuckles

Until November 2013 my right hand didn’t tolerate a strong handshake, but I have a noticed that the PE foam disc squeeze helped. 

Stiffness

The morning stiffness diminished, when I made myself a new, more rigid polyethylene foam disc and started to use fingerless woolen gloves at night. 

Swelling

In September 2013, 6 months after the operation, the fingers started to return to normal size.


First symptoms of Dupuytren's contracture


The first symptoms of
Dupuytren's contracture
In September 2013 I noticed in my right hand  callus-like nodules under the ring and middle finger, and in the beginning they were tender to the touch. 

After I carried some heavy stuff out, I noticed that I couldn't extend my right hand straight without extra effort, otherwise it stayed a little bent. My little finger had a tendency to be bent more forward than the other fingers, but the PIP-joint isn't bent, like was in my left hand in 2010. When I did stretching exercises for the hand, I felt pulling sensation specially in my little finger. 
First contractions
There was a period when if I did ironing or vacuum cleaning, I had the feeling that I still had the device in my hand, even though I had stopped the ironing or cleaning. 
When I had this kind of feelings, I did some stretching exercises immediately, and it helped. During this period, which lasted few weeks, I avoided carrying heavy loads.
My right hand Dec 2013
I searched in the internet for the early signs of Dupuytren's contracture and found that they were quite similar. 

 Because the stretching exercises helped my left hand, I tested if I can get positive result with daily stretches, even though some web sites warn against them. The problems of my right hand were somewhat different, than in left hand, but I believe that in both cases the reason was the disposition to Dupuytren's contracture in the family, activated with physical trauma and age.

In December 2013, I can see that the daily stretching exercises have had a positive effect. I could see the first results in two weeks, because the stretching exercises were suitable to my hand,  If not, the exercises give only temporary results. The callus-like nodules stayed, but I'm able to extend the fingers straight.


When the hand or fingers are too contracted or stiffened, the stretching exercises doesn't help anymore.

When I had problems with the bent fingers of my left hand, I noticed that the rehabilitation and stretching exercises should start as soon as possible, because my fingers stiffened in three months and then they had to be operated. 

After the operation fingers started to bend again, but two moths later I found the right stretching instruction for straightening, early enough to give results. Now my left hand look's like this, the picture is taken in September 2013.

Now I need to exercise both hands regularly.

Exercises

PALM STRETCH AGAINST A WALL

Pull the palm against a wall and press your hand against it. Then turn the arm to more upright position so that the angle of the wrist is bigger; hold the stretch for 10 seconds. Repeat three times.

In case you have a warm wall surface, for ex. an internal hot water pipe in your bathroom, use this area for the stretch, it feels better. This is a good stretch in case of the "calluses" in the hand.

The better you get your hand against the wall and the bigger angle you get in your wrist, the better the stretch. 
If you can’t get your hand tight against the wall, push with the other hand.

PULLING CONTRACTURE - A MORE EFFICIENT STRETCH

In case you have a callus like nodule under your ring finger and pulling sensation in your palm, you can test this stretch, but only if your palm is still flexible and there isn’t yet a visible contracture in your palm.

Push your hand against a wall so that you can turn your wrist in right angle. 
Press with the other hand so that your knuckles and fingers don’t move.
Lift your wrist a little from the wall and keep this position during 10 sec. 
Repeat the exercise a few times and again during the day.

Some times you feel a pulling sensation only when you do a stretch, therefore it is important to continue stretching exercises, even though there aren’t any strange feelings in the normal use of the hand. 
After a pause, the pulling sensation may be much stronger, and then you need to exercise more often.

2. The situation one year later


I noticed two callus like nodules in my right hand in September 2013 and started the daily stretching exercises at the same time, with some exemptions.
After 6 months I had  still the nodules in my hand, and if I beard heavy things or did handiwork, they some times felt tender and I also felt a pulling sensation in my hand. Then, I stretched the hand more often.
However, the nodules were about the same size.

One ear later the nodules are still visible, but they look a little bit smaller.
There are no special sensations in the hand, even if I carry heavy loads. However, I stretch the palm from time to time, specially if I'm traveling.
This picture shows the situation in September 2014.

3. An evident case of of Dupuytren's contracture in the family

All orthopedic links recommend operation, and if nothing else is done, there may be need for several operations. My cousin has this problem also, and he has had together 11 hand operations. He didn't get any instructions for stretching but used splints made by hospitals.

Right hand

Left hand

4. Orthopedic links, Dupuytren's contracture, vitamin D

Information on orthopaedic conditions and treatments, injury prevention, wellness and exercise, and more. Without advertisement.
American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/menus/hand.cfm
Information about fractures, injuries, pain relieving and different hand problems: Arthritis of the Thumb, Boutonnière Deformity, Dupuytren's Contracture, Trigger Finger; ...

Orthogate and the Internet Society of Orthopaedic Surgery and Traumatology (I.S.O.S.T) http://www.orthogate.org/patient-education/hand/
Patient Education Guides about hand pain and problems, and anatomy.

Orthogate website is certified by the The Health on the Net Foundation http://www.hon.ch/
Dupuytren's contracture: 
Osteoporosis risk factors

There are many opinions concerning the treatment of a Dupuytren's contracture before operation, but they do not mention stretching: 

Splinting does not prevent increased bend in the finger. Forceful stretching of the contracted finger will not help either, and may speed the progression of contracture.

For a severe problem, a therapist may be able to make a custom splint or brace to stretch the fingers out a little more straight. If surgery can't be done, this may help regain some movement of the fingers, but requires using the splint every day.

Splinting and hand therapy are often required after surgery.

Splinting or stretching and local steroid injections are not recommended.

Although injury and excessive hand use are not believed to cause Dupuytren’s, higher rates of Dupuytren’s disease have been observed in people with hand trauma.



800 IU = 20 mikrog vitamin D
Vitamin D supplement is best absorbed when you take it with food containing fat.

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