Is proliferative fibroplasia of subcutaneous palmer tissues, forming nodules of cords along its ulnar border.
This condition is characterized by flexion deformity of one or more fingers due to thickening and shortening of palmar aponeurosis.
Normally, palmar aponeurosis is thin while in Dupuytren’s contracture, aponeurosis becomes thickened and slowly contracts, drawing finger into flexion at distal finger joints
Nodules and cords develop due to hypertrophy and fibroplasias of already existing fibres.
The main causes for Dupuytren’s contracture include- Heredity, Trauma, People those who are employed in rock drilling work, owing to pigmentation White people might be more affected than blacks, Males are at higher risk of affection than females, Onset is usually below 40 of age and usually begins at ring finger.
- Clinical features include – thickening of palmar aponeurosis in early stages.
In later stages, flexion deformity might be formed as well as Contracture of flexor tendons may occur.
Initially, Distal joints of fingers goes into flexion.
- Treatment plan starts by observing and assessing.
Initially conservative approach is preferred that includes Physiotherapy measures like
– Thermotherapy such as application of paraffin wax bath, ultrasound, short wave
– relaxed passive exercises
– active assisted exercises
In some cases, radiotherapy can be performed in order to shrink and soften lumps and prevent formation of contractures.
Surgery can be performed in more painful and chronic cases.
DE QUERVAIN’S TENOSYNOVITIS
It is a painful condition resulting from affection of tendons on thumb side of wrist.
Inflammation of common sheath of abductor pollicis longus and extensor pollicis Brevis tendon causes this condition.
The clinical features include – Pain, swelling over radial styloid process, Localised tenderness, Pain aggravated by adducting thumb across palm.
In addition to that, repetitive hand or wrist might alleviate the pain and worsen the condition.
Usually, Finkelstein’s test is performed to confirm the condition – forcing ulnar deviation and asking patient to perform radial deviation against resistance.
Also, Palpable thickening of sheath can be felt.
TREATMENT protocol includes – rest and cold compression, wrist in crepe bandage or slab, analgesics, ultrasonic radiation in early stage of the condition
If the condition persists for long then in chronic stage – it requires slitting and excision of part of tendon sheath
Also, in some cases, local infiltration of hydrocortisone injection can be given.