Class IV Low Level laser Treatments For Dupuytren's Contracture
Dupuytren's contracture usually occurs slowly over time in the progressive flexion of the little and ring fingers. Slowly the fingers become harder to straighten out and it may become painful to do so. The fingers can be flexed but not straightened, and a bump is felt under the skin. Excessive tissue is accumulating and causing the connective tissue to thicken, which will eventually prevent the fingers from straightening. Dupuytren’s contracture makes it difficult to perform everyday activities with the hand, such as putting your hand in your pocket or shaking hands.
The cause of Dupuytren's contracture is unknown. The thickening of the connective tissue occurs on the flexor tendon, usually of the 4th or 5th digit. At first a thickening of the palm of the hand is noted, and dimples may appear. Eventually a lump on the palm of the hand or finger will be found. It can be sensitive to the touch but rarely is painful. If the condition progresses, fibrotic cords can be felt running from the palm of the hand toward the fingertips.
Although it typically occurs in the two little fingers, it can also affect the index finger or thumb. It can affect both hands in some cases. It is more common in older men of Northern European descent. Even with the slow development and progression of the condition, severe and disabling cases do occur, especially with old, stubborn men who ignore it. I can say this because of my family’s predominance of stubborn Northern European men who ignore all things related to health.
The pictures included in this article are from a family member who waited more than 15 years before seeking treatment. Needless to say surgery was required. He waited too long before the surgery, which limited his functional gains and improvement. The truth is he would have waited longer, but his other hand progressed to the point that he could not get his keys or wallet out of his pockets. Unable to use either hand was the ”final motivation” required for him to seek treatment (on one hand only because he didn’t think he needed surgery on both).
Treatment involves decreasing the inflammation or irritation associated with the contracture. In many of the mild and early cases, the condition is not painful and swelling is usually mild. In more advanced cases the fingers can become painful when stretched. In these cases therapeutic treatment modalities to decrease pain and inflammation can be used, such as ice, heat, electric, or ultrasound therapy. Mild stretching exercises will be given to enhance flexibility of the fingers and help break up the fibrosis or scar tissue between the soft tissue. Stretching of the fingers can be painful but is very necessary.
Additional treatment options include needling, which utilizes a needle inserted through the skin to puncture or break up the cords that are contracting the fingers. Your healthcare provider is very careful not to use the needling technique in some locations because of potential damage to nerves or tendons.
Graston technique is an excellent treatment for breaking up scar tissue and fascial adhesions in muscles, tendons, and ligaments. Graston technique utilizes stainless steel instruments to slide along the skin to help pull one layer of tissue past another. The sheer force produced breaks up the scar tissue and helps trigger the body's healing processes for repair and tissue regeneration. Stimulating the body's normal repair mechanisms helps produce normal tissue to replace the bad scar tissue formation.
Graston technique is excellent in the mild and moderate stages of the condition. This is a beneficial treatment with any muscle and tendon injury, and often helps many patients avoid surgical intervention. However severe cases of Dupuytren’s contracture will require surgical intervention. Many times Graston technique is utilized post surgery to break up additional scar tissue and prevent re-formation of the contracture post surgery.
Class IV K cold lasers are excellent treatments at decreasing pain and inflammation and are used in many tendon treatments. Class IV cold lasers are also excellent at stimulating a body's normal repair and regeneration mechanisms. Specific wavelengths trigger increased ATP production within the soft tissues of the hand, which allows the cell to spend more energy for repair and healing. In addition to accelerating repair and regeneration pathways, cold lasers help decrease bad scar tissue formation or fibrosis. The wavelengths are stimulating proper healing and can inhibit bad scar tissue formation, which has played a role in the development of Dupuytren's contracture.
Enzyme injections are also utilized in some cases to help soften and weaken the scar tissue cords. This will help your healthcare provider to manipulate your hands and help to break up more of the scar tissue. This procedure is usually not painful except where the enzyme is initially injected into the tissue.
The most severe cases often require surgery to remove the excessive tissue in the palm of the hand. This is often a difficult and challenging surgical procedure because of the late stages in which many patients seek treatment, thereby resulting in extensive scar tissue throughout the palm of the hand and soft tissues. Oftentimes severe cases require surgery and extended physical therapy to prevent future reoccurrences.