Dupuytren’s contracture is a debilitating condition that imparts serious disturbances in the routines of an affected individual. This contracture producing deformity renders the hands’ ability to smoothly perform the physical activities of daily life. The result is a physiological and well as a psychological burden on the patient that unfortunately decreases their quality of life. The condition is associated with nodule formation in the palmar surface of the hand and spaces between the digits, which leads to the shortening of the palmar fascia. Together these changes maintain the constant flexion of the fingers, causing discomfort and pain on movement.
Fortunately, multiple management modalities have been proposed that address such complaints. These include medications, physiotherapy, and the last resort surgical corrections. The surgical manipulation has a high success rate and offers the maximum symptomatic relief possible, however, it is associated with its subset of complications and limitations. Such as expensive procedure cost, risk of infection, damage to nerves and vessels, etc. Multiple studies report a 17% complication rate in surgeries carried out for the correction of Dupuytren’s contracture. Post-operative rehabilitation is also found to be frequently challenging in such patients. These factors along with a low pain threshold make invasive procedures less preferred options by most patients.
Therefore, recent medical advancements have been specifically directed towards introducing tools and devices that can easily be employed at home by patients themselves to produce effective results. Literature shows an adequate amount of clinical trials and studies that can back the use of ultrasound devices, stretching tape, and therapeutic heat as some practical solutions. Mentioned below are few such pieces of research that statistically verify these claims:
HEAT AND RADIOTHERAPY:
Application of heat to relax and smoothen the fascia is recommended in the early stages of Dupuytren’s contracture. This is proposed to not only help increase the range of motion of the fingers and palm but also to slow down the progression of the condition. Radiotherapy is appreciated by many physicians and patients as it is a pain-free modality with minimum to no procedure-related complication.
Several qualitative studies report it as an effective alternative for patients that do not prefer surgical correction.
The role of fibroblasts in the development of Dupuytren’s contracture is of particular importance when approaching a treatment option. The excessive and uncontrolled proliferation of the fibroblasts into myofibroblasts causes the characteristic nodule formation associated with the condition. This explains the radiologically identified muscle cells characteristically required for the diagnosis. These myofibroblasts have an undesirable quality of avoiding apoptosis and expressing a special protein, that further enables them to elicit contraction and replicate the behavior of smooth muscle cells. Any stimulus or protocol that inhibits these myofibroblasts from synthesizing the mentioned protein in the first place may help in preventing the progression of this disease from controlled to advanced stages.
A clinical trial conducted in Germany followed 96 participants with Dupuytren’s contracture for 5 years. These patients were advised to receive radiotherapy daily for the duration of the trial. It was later observed that 92% of the participants remained stable at 3 months follow-up, 7% had improvement in their complaints and only 1% reported progression of the condition. A visible reduction in the cords and nodules was noted in 75% of the cases in the same follow-up. In the long term follow up carried out after a period of five years researchers recorded a 77% absence of disease progression.
Another study conducted in Germany focused on the genes involved in the pathogenesis of Dupuytren’s contracture concluded positively on the effectiveness of radio waves in diminishing the proliferation and maturation of myofibroblasts by manipulating them at the molecular level.
Prophylactic Radiotherapy
In an experimental study carried out in two subsets of patients discriminated against on random selection, the effectiveness of radiotherapy was evaluated in patients suffering from the early stages of Dupuytren’s contracture. A time frame of 1 year was allotted for observation of both subsets of patients with results recorded at several intervals of this duration. It was found that the group receiving radiotherapy showed a higher incidence of regression and disease stabilization in comparison to the group receiving none.
The study thus concluded the prophylactic usage of radiotherapy to be successful in achieving disease regression and improvement in overall symptoms in the patients suffering from Dupuytren’s contracture.
Ultrasound Therapy
The use of ultrasound devices for the management of Dupuytren’s contracture has been rationalized due to its ability to soften and increase the extensibility of the fibrous tissue. A study following patients receiving low-intensity therapeutic ultrasound, found it to be inducing improvement in hand functioning and range of motion. The research utilized tools such as goniometer to measure the degree of active digital joint expansion, hand span in centimeters, power grip strength measured in pounds, and palmar consistency assessed by clinical examination. The participants were exposed to ultrasound therapy regularly for a period of over 5 to 8 weeks. The result recorded at the end of the trial showed improved digital extension in between 5 to 23° in 67% of the patients with noticeable palmar softening. Handspan increased in 2/3rd of the patients by 0.7 and 2.4 centimeters and grip strength improved in all participants by between 3 and 6.5 pounds.
Therefore, the application of ultrasonography in treating diseases related to musculoskeletal origin such as Dupuytren’s contracture has now become widely popular due to noninvasive nature and minimal to no complication rate.
Taping
Over the years, taping for finger splints has been introduced as an easy fix to common complaints such as decreased range of motion and hand stability in patients suffering from Dupuytren’s contracture. Multiple studies comment on the use of medical tape to reduce the intensity of pain, along with strengthening hand grip. Splitting digits with tape facilitates the flexion and extension movement by fixing the hand in an appropriate resting posture.
Two studies report the use of tape-based night splints in patients with early Dupuytren’s contracture to increase the degree of active individual digital joint extension when assessed with a goniometer. The study proposed the concept of low load tension promoting tissue remodeling as a result of increased matrix metalloproteinase activity.
Combining the three modalities:
In light of the above-mentioned discussion and research studies put forward the three management modalities i.e. radiotherapy, ultrasound, and taping, qualify as a strong alternative solution to surgery in most patients with Dupuytren’s contractures. When employed together at the same time these unsightly produce amplified results of alleviated symptoms and low complication risks.
References:
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