Dupuytren's contracture (palmar fibromatosis)

Why does pathology develop?

The disease does not have a single cause; many factors can provoke it. People at risk include those who have:

• hereditary tendon problems;
• hand injuries;
• osteochondrosis of the cervical vertebrae;
• arthritis;
• diabetes;
• difficult working conditions;
• bad habits (smoking, drinking alcohol, sedentary lifestyle);
• diseases of the nervous system.

The main risk group is men over 40 years of age, residents of the eastern part of Europe and northern regions. However, sometimes, in the presence of provoking factors, pathology can develop in other groups of the population.

Orthopedics and traumatology services at CELT

The administration of CELT JSC regularly updates the price list posted on the clinic’s website. However, in order to avoid possible misunderstandings, we ask you to clarify the cost of services by phone: +7

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Make an appointment through the application or by calling +7 +7 We work every day:

• Monday—Friday: 8.00—20.00
• Saturday: 8.00–18.00
• Sunday is a day off

The nearest metro and MCC stations to the clinic:

• Highway of Enthusiasts or Perovo
• Partisan
• Enthusiast Highway

Driving directions

How does the disease develop and progress?

Detecting Dupuytren's contracture can be quite difficult - at the initial stage there is practically no pain. The main symptom of the disease is a thickening in the joint between the finger and the metacarpus. In this case, the finger gradually ceases to extend. A dense nodule will increase in size, causing the tendon to shorten and the finger to move more and more limited.

The disease has four stages:

1. Compaction up to 1 centimeter, no pain. It is advisable to consult a doctor, start conservative therapy or perform a subcutaneous aponeurotomy.
2. The nodule has increased in size, moving to the digital phalanx; the finger does not fully extend (up to 30 degrees).
3. It is completely impossible to straighten the finger; the limit is 30-90 degrees. The functionality of the hand is severely limited; at this stage, treatment requires open surgery.
4. The finger is always almost completely bent; extension is limited to 90 degrees. The process affects tendons, joints and skin.

It is necessary to start treatment as early as possible - consult a doctor as soon as you notice difficulties in finger movement. The neglect of such a serious pathology can lead to amputation.

Methods for diagnosing and treating palmar fibromatosis

Sometimes an orthopedist-traumatologist can establish a diagnosis during an initial examination. The doctor determines the degree of deformation, the functioning of the hand, the angle of extension and the presence of nodules. But for an accurate diagnosis, it is necessary to take an x-ray of the hand.

Treatment can be conservative or surgical. In the early stages of the disease, conservative treatment is used. To do this, a course of medication is prescribed, a splint is used on the arm, and therapeutic exercises are performed.

The purpose of the surgical intervention is to get rid of the nodes on the skin of the palms and excision of the aponeurosis strands that go to the fingers. For this purpose, excision of the palmar aponeurosis is used: fasciotomy, fasciectomy or dermofasciectomy. The choice of treatment method depends on the advanced stage of the disease and its spread to tissues. The intervention is performed under local anesthesia and lasts up to 60 minutes. The surgical wound heals within two weeks.

Fasciotomy is performed through open and closed access. Using a scalpel, an orthopedic traumatologist excises the affected fascia - the membranes that cover the muscles, tendons and neurovascular bundles. This allows the finger to be aligned at the metacarpophalangeal joint and makes it easier to perform hand functions.

Fasciectomy is an excision of the altered palmar aponeurosis, which can be segmental, limited or radical. During segmental fasciectomy, short (no more than 2 cm) affected areas are removed, which makes the rehabilitation and postoperative period much faster. Limited fasciectomy is indicated in the initial stages of contracture development. The operation is performed while preserving the transverse fibers, which protect the neurovascular bundles. Radical fasciectomy is a traumatic operation with large excision of fibers. There is a risk of hematoma formation and hand stiffness.

Dermofasciectomy involves excision of a large amount of tissue, including areas of healthy skin. Subsequently, the removed parts are restored using a skin graft. The operation is performed for significant lesions and shortening of the skin due to Dupuytren's contracture.

How is Dupuytren's contracture diagnosed and treated?

Diagnosis of the disease begins with collecting anamnesis and examining the patient by a doctor. If necessary, radiography of the hand is used. The amplitude of finger flexion is assessed. Treatment of Dupuytren's Contracture depends on the stage and characteristics of the disease. At an early stage, conservative therapy is possible to slow the progression of the disease:

• gymnastics, exercise therapy;
• physiotherapy;
• fixation with plaster or splint;
• massage;
• drug injections.

The Department of Traumatology and Orthopedics of the ABIA Clinic also provides surgical treatment of Dupuytren's Contracture. Depending on the stage of the disease, a subcutaneous (percutaneous) aponeurotomy or open classical excision of the tendons and restoration of finger mobility are performed.

Aponeurotomy

Expert opinion

Commented by D.P. Zonova, traumatologist-orthopedist at Doctor Ost Medical Center.
Aponeurotomy for contracture is the gold standard of treatment today. During aponeurotomy, the rays of the palmar aponeurosis can be re-divided into parts. The subcutaneous dissection of the pathologically altered palmar tendon is the whole essence of aponeurotomy. Due to this, traction (stretching) of the crooked finger occurs, eliminating blocks in the metacarpophalangeal and interphalangeal joints.

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NEEDLE APONEUROTOMY: ADVANTAGES OF THE METHOD

• Efficiency up to 100%.
  If you undergo the procedure on time, you can completely restore range of motion and relieve the patient of all signs of the disease.
• Quick results.
  As a rule, patients with any stage of Dupuytren's contracture need one procedure. The very next day after the spasms in the arm are relieved with needles, you can return to your usual daily activities. Compare: after open surgery there is always a rehabilitation period, which can last for several weeks.
• Safe and careful.
  Needle aponeurotomy minimizes the risk of complications and repeated exacerbations of the disease.

NEEDLE APONEUROTOMY FOR DUPUYTREN'S CONTRACTURE: PROGRESS OF TREATMENT

Aponeurotomy is preceded by examination and consultation with a doctor. An orthopedist determines the prognosis for treatment of Dupuytren's contracture using needle aponeurotomy in a particular patient.

PROGRESS OF TREATMENT:

The skin of the hand is treated with an antiseptic solution. The surgical field is anesthetized with lidocaine solution. The doctor works with an injection needle in the projection of the tendons, making pinpoint punctures. The procedure is quite comfortable and takes no more than 30 minutes. The doctor will only have to check the sensitivity and hemostasis in the tissues. An aseptic bandage is applied to the puncture sites. Treatment complete! You can go home!

ASSISTANCE TECHNOLOGIES

In order for healing to proceed successfully and movement in the fingers to be maintained, rehabilitation is recommended. These are several sessions of ultrasound with lidase, a component that restores the firmness and elasticity of the tendons. Or several sessions of shock wave therapy, ridding the hand of growths and fibrous formations. For some, it will be enough to wear a custom-made orthosis for some time. It is light and comfortable, does not restrict movement, but fixes the hand in an anatomically correct position, allowing the tendons to further lengthen.

HOW MANY TIMES DO YOU NEED TO PASS A NEEDLE APONEUROTOMY?

Reviews of needle aponeurotomy from our numerous patients confirm the effectiveness of this treatment method: range of motion in the fingers returns, pain goes away, and repeat procedures are not required.

“After the stroke, my fingers curled up, I couldn’t fully use my hand, the treatment in the hospital didn’t help, and I had already come to terms with this sore, but then I heard about needles in Doctor Ost.” It's hard to believe, but thanks to this treatment, my fingers were back in place in just one visit! Read the full review >>

NEEDLE APONEUROTOMY: COST

how much does it cost? The price of needle aponeurotomy for Dupuytren’s contracture is published in our Price List in the “Intra-articular injection” section.

With Dupuytren's contracture, the cost of treatment may not be limited to just the aponeurotomy session. Depending on the severity of the disease and for a speedy recovery, the doctor may make additional appointments. For example, making a custom wrist orthosis to fix the tendon in the correct position. Or UVT treatment, which can restore ligaments and tendons to their former elasticity. A set of measures always brings more pronounced and stable results!

WHERE TO GET TREATMENT FOR DUPUYTREN'S CONTRACTURE

The Doctor Ost clinic is fluent in the needle aponeurotomy method. Needle relief of arm spasms is offered as a modern alternative to more prescribed surgery. And although the procedure is simple in its essence, it nevertheless requires certain skills and experience.

According to the official version of the annual competition for the title of Best Clinic, Doctor Ost is the best medical center for the treatment of the musculoskeletal system in general. And hand therapy, in particular, in our medical center is presented at the highest level. We have created all the necessary conditions for carrying out medical services, such as aponeurotomy and more! Our doctors have modern equipment and innovative technologies at their disposal! You should not be rash in choosing a doctor who you can trust to treat your hand. Contact the professionals!

Question and answer “My mother’s fingers are curled up on her hand, she can hardly move them, can this be cured at your Doctor Ost without surgery?”

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Disease prevention

Preventing the development of Dupuytren's Contracture is much easier than treating it later. You need to take care of your hands; the following measures will also help:

• during heavy physical work, use a skin softening cream and wear protective gloves;
• periodically warm up your hands by bending and straightening your fingers;
• For any injuries, undergo regular examination by a doctor.

Professional doctors, advanced technologies and modern equipment of the ABIA clinic allow for accurate diagnosis and effective treatment of diseases of the musculoskeletal system.

Symptoms

The disease manifests itself quite characteristically, it cannot be confused with any other. First, a small dense nodule appears on the palm. It gradually grows in size, then cords appear that extend from it towards the finger and wrist joint. Ultimately, the ring finger takes on a bent position, in which it remains constantly and can no longer straighten.

Gradually, the same changes can occur with other fingers. Over time, pathological changes only increase, the tendon thickens even more, and the mobility of the fingers is limited. However, pain occurs relatively rarely, only in every tenth patient.

Usually the doctor makes a diagnosis after an examination. Having read the complaints and examined the palm, the specialist no longer doubts what his patient’s illness is. Sometimes, to clarify the diagnosis, it is necessary to conduct an ultrasound examination of the tendons of the palm and perform x-rays of the hands.