It is not recommended for use in case of Dupuytren's contracture. Symptoms and diagnosis of Dupuytren's disease - treatment, surgery and rehabilitation course. Collagenase injection - a new trend in medicine

Dupuytren's contracture is a disease characterized by cicatricial degeneration of the tendon tissue of the palmar aponeurosis, leading to limited extension (flexion contracture) of one or more fingers. It is named after the surgeon from France, Guillaume Dupuytren, who almost two centuries ago (in 1832) described its clinical picture in detail. The second name of the disease is palmar fibromatosis.

According to statistics, about 3% of the population of our planet suffers from this pathology. Men of mature age – from 40 to 60 years old – are more often affected. Only in 4-8% of cases of the disease is it diagnosed in women.

Dupuytren's contracture is not a fatal disease, but it leads to persistent impairment of hand function, which is unacceptable for able-bodied men. Recognized in the early stages, it is subject to conservative treatment, which includes, in addition to medications, massage and physiotherapy techniques, and in some cases significantly slows down the progression of the disease.

That is why it is important for every person to have an idea of ​​what palmar fibromatosis is, why it occurs and how it manifests itself, as well as methods for diagnosing and treating this condition - both non-surgical and surgical. These are the points that will be discussed in our article.

Causes and mechanism of development

Although Dupuytren’s disease was discovered quite a long time ago and there are already many publications on this topic in the medical literature, scientists still cannot confidently say why this pathology occurs. It has been proven that heredity is of great importance - in the genotype of members of one family suffering from palmar fibromatosis, a gene was discovered that is absent in healthy individuals. But not all carriers of this gene get sick. It is likely that for the disease to manifest itself, the body of a person predisposed to it must be exposed to one or more risk factors. These are:

• hand injuries (both a single severe injury and multiple minor injuries);
• bad habits (smoking, alcohol abuse);
• working conditions (profession that involves heavy manual work);
• age, gender (men over 40 years old);
• some diseases of other organs and systems (epilepsy, liver disease and others).

So, a person who has in his genotype the gene responsible for the development of Dupuytren's contracture is exposed to one or more of the factors listed above. In the area of ​​the tendons of his palms (palmar aponeurosis), a number of processes are activated, the result of which is the replacement of physiological tendon tissue with pathological scar tissue. This leads to the appearance of clinical signs of the disease.

Symptoms, periods and stages of the disease

Dupuytren's contracture is a disease with a chronic, steadily progressive course. If it develops in adulthood, it usually progresses slowly, but in young people it is more aggressive and develops rapidly.

In most cases, at the initial stage of the disease, only individual rays of the palmar aponeurosis (usually the fourth or fifth finger) of one hand are affected. Over time, the pathological process spreads, and at the end of the disease, total (complete) cicatricial degeneration of the tendons of both palms is determined.

Clinicians distinguish 4 conditional periods of Dupuytren's contracture, each of which is characterized by certain symptoms:

1. Preclinical. Even before the typical symptoms of this pathology appear, many patients experience morning stiffness, a feeling of fatigue, heaviness, aching pain in the hands, and numbness in the fingers. Sometimes there is dryness, slight thickening of the skin of the palms, and flattening of the folds on it. This period lasts for a long time – up to 8 years.
2. The period of initial manifestations. A person notices the appearance of the first symptoms of the disease - atrophic changes in the subcutaneous fatty tissue, nodes located under the skin, as well as depressions on it. It lasts up to two years.
3. Progression period. The area of ​​the lesion gradually increases - not only nodules are detected under the skin, but also coarse connective tissue cords along one or more fingers, especially clearly visible when the patient tries to straighten the finger. A flexion contracture is formed, that is, the patient cannot fully straighten the affected finger due to the fact that the tendon, replaced by scar tissue, shortens and becomes inelastic. Also on the palm there appear clearly visible depressions in the area of ​​skin folds, funnel-shaped retractions, areas of peeling, inflammation, and atrophy. In some cases, bedsores even develop. The skin is rough and dense.
4. Late period. The palmar aponeurosis is completely involved in the pathological process. Flexion contractures of several joints developed (the so-called fibrous ankylosis), and dislocations and subluxations occurred in the adjacent joints. The skin is dense, rough, dry, subcutaneous fatty tissue is atrophied. There is simply nowhere for the disease to progress further, so it no longer develops. But this does not make it easier for the patient, because the functions of the hand are seriously impaired, and in order to at least partially correct them, a series of surgical interventions is necessary.

Pain is practically not typical for this pathology - only 10% of patients report pain in the affected area.

Depending on the severity of finger contracture, there are 4 degrees of the disease:

I – in the area of ​​the IV or V ray of the palmar aponeurosis (that is, the tendons of the corresponding fingers), a compaction located under the skin is determined; it does not interfere with a person’s everyday life at all, since it does not affect the extension of the finger; Of course, at this stage only a few patients seek medical help.

II – the disease progresses; finger extension is limited to 30°; patients note some visual defect of the hand and a slight limitation of its functions, but at this stage only a small part of them consult a doctor, while the majority hope that “nothing is wrong” and “everything will go away on its own.”

III – it is impossible to straighten the affected finger; it is at an angle of 30-90° to the hand, the function of which is sharply limited; Here, patients already go to the doctor for help, but he cannot offer them anything other than a series of operations to restore the functions of the hand.

IV – passive extension of the finger is maximally limited – more than 90°, there are dislocations and subluxations of the interphalangeal joints; The prognosis for the hand at this stage of the disease is extremely unfavorable.

Diagnostic principles

The diagnosis is based primarily on specific clinical data, taking into account the patient’s complaints and medical history.

As a rule, any laboratory or instrumental diagnostic methods are not required to make a diagnosis. In some cases, for the purpose of differential diagnosis, radiography of the hands may be recommended to the patient.

Treatment tactics

Treatment of Dupuytren's contracture should be comprehensive; it aims to eliminate or at least reduce the flexion contracture of a finger or several fingers. Depending on the stage of the disease, the patient is prescribed conservative treatment or surgical intervention.

Conservative treatment

Conservative therapy methods do not lead to recovery of the patient, but only slow down the progression of his disease. They are most effective at stage I of the pathological process, but can also be prescribed to a patient if he categorically refuses surgery, as well as at the stage of rehabilitation after it.

Treatment is carried out without surgery in a clinic twice a year. Its components are:

• taking medications;
• physiotherapy.

Among the medications, the patient is usually prescribed:

• injections of glucocorticoids - dexamethasone, diprospan and others (inhibit the inflammatory process and reduce pain);
• applications to the affected area of ​​proteolytic enzymes - lidase, trypsin, ronidase and others (activate metabolic processes in the affected tissues, soften scar tissue, slow down degeneration);
• Xiaflex is a specific combination drug, the ingredients of which have a destructive effect on collagen; intended specifically for the treatment of Dupuytren's contracture; administered by injection into the area of ​​contracture.

Physiotherapy

The techniques are an important component of the complex conservative treatment of Dupuytren's contracture, and are also used at the stage of rehabilitation after surgery.

A doctor, prescribing one or more physical therapy methods to a patient, pursues the following goals:

• activation of metabolic processes in the affected areas of the palmar aponeurosis;
• resorption of scar tissue, and if this is not possible, then at least softening it;
• restoration of range of motion in the joint involved in the pathological process.

The following will help reduce the tension of scar tissue:

• low frequency electrotherapy;
• infrared;
• local (helps improve tissue nutrition in the affected area; a labile technique is used with a current strength of no more than 10 μA; session duration is 10 minutes, the course of treatment includes 8-10 impacts).

The following techniques improve the condition of the scar:

The following methods slow down the process of scar formation and activate the resorption of scar changes:

• compresses with dimexide and proteolytic enzymes - lidase, trypsin, ronidase and others (the drugs destroy the peptide bonds of scar collagen without affecting physiological collagen; ronidase powder is poured onto a gauze cloth previously moistened with boiled water, then applied to the affected area, covered with a special paper, cotton wool and fix in this position for 12-18 hours; make such a compress every day for a course of up to 30 treatments; if lidase is used, its solution is mixed with a solution of novocaine and the resulting mixture is applied to the scar; the course of treatment includes up to 30 sessions) ;
• medicinal and theirs.

To expand the blood vessels in the damaged area, thereby improving blood flow to it, the patient is prescribed:

• warming compresses;
• medium wavelength in erythemal doses;

To stimulate the work of the hand muscles, use:

Surgery

Flexion contracture of the finger with an angle of more than 30° (that is, stage III of the disease) is a direct indication for surgical intervention. Many experts believe that it is necessary even earlier - at stage II, if the patient has already consulted a doctor. However, with regard to the latter situation, an individual approach is important here, taking into account the characteristics of the course of the disease (the rate of its progression, the presence of predisposing factors, the patient’s age).

The purpose of the operation is to excise the tissue affected by the pathological process to restore as much as possible the range of motion in the joint. It is performed under local anesthesia or general anesthesia. After suturing the wound, the surgeon applies a thick sterile bandage to the palm and fixes the finger in a physiological position with a functional splint. The patient wears it from several weeks to several months, depending on the stage of the disease.

Particularly severe cases require a different tactic of surgical intervention, called arthrodesis. Its essence is to create a joint incapable of movement, while fixing the finger itself in the position that is most beneficial for it. That is, as a result of this operation, the finger will not work, but it will be in a physiological position, which is quite comfortable for the patient and is not a cosmetic defect.

In some cases, usually at stage IV of palmar fibromatosis, the doctor recommends the patient to amputate (remove) the affected finger.

At stages III and IV of the pathological process, the patient often requires not one, but several consecutive operations.

Despite the fact that surgical treatment allows the patient to increase the functional ability of the hand and improve his quality of life, in almost half of the cases of the pathology we describe, relapses occur after surgery. The risk is especially high in young patients with rapid progression of the disease. Such situations require repeated surgical intervention.

Previously, operations performed for Dupuytren's contracture were accompanied by a high risk of developing all kinds of complications. Today, many clinics have in their arsenal modern microsurgical equipment with good optics, which allows them to minimize the risk of postoperative complications and significantly reduce the rehabilitation period.

As rehabilitation measures, the patient is prescribed therapeutic massage, exercise therapy and physiotherapy procedures listed in the previous section.

Conclusion

Dupuytren's contracture is not a rare disease. Although it is not fatal, it is still extremely unpleasant for the patient, as sooner or later it leads to permanent deformities of the hand. In the early stages of the disease, the doctor recommends non-surgical treatment to the patient, including medications, therapeutic massage and physical therapy techniques. Such therapy will not lead to recovery, but can significantly slow down the progression of the disease, maintaining the functionality of the hand. In advanced cases of the pathological process, surgical intervention cannot be avoided, however, it does not guarantee the restoration of range of motion in the affected joints.

From what has been written above, it follows that it is important for every person to be attentive to their state of health and, if their health worsens, to consult a doctor. In this case, the likelihood of a positive treatment result is maximum. And it’s better for those around you to consider you a reinsurer than later to reproach yourself for not being able to turn back time in order to receive medical care in a timely manner.

Center for the treatment of Dupuytren's contracture, a specialist talks about the causes, symptoms and treatment of this pathology:

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Dupuytren's contracture is considered a fairly common pathology: according to some data, up to 20% of Europeans suffer from it. Although not life-threatening, the disease significantly complicates the performance of professional tasks, self-care, and even leads to disability, requiring radical measures on the part of surgeons and orthopedists.

Surgery for Dupuytren's contracture is considered by most experts to be the optimal method of treatment, but there is still no uniform surgical tactics, just as approaches to assessing indications may be diametrically opposed in different clinics.

Dupuytren's contracture is an overgrowth of fibrous tissue with cicatricial deformation of the tendons of the hand. Gradually worsening, the disease leads to a significant limitation of the mobility of the fingers, up to complete immobilization. In almost half of the cases, the tendon of the ring finger is affected.

Among the patients there are up to 10 times more men than women, the disease often begins at a young and most active age, so it is impossible not to notice disability. Conservative treatment, which is possible only in the initial stages of the disease, and surgery, as the most radical and effective method, help prevent disability.

Neither the exact cause nor the mechanism of scar changes in the palm have been thoroughly elucidated, therefore pathogenetically based conservative therapy has not been developed, and the methods used are aimed at relieving pain, increasing range of motion, and inhibiting the progression of fibrosis.

The efforts of surgeons are aimed at finding not only the most effective way to eliminate pathology, but also the type of skin incision, which determines visibility in the surgical field, cosmetic effect and the degree of scarring after surgery. Today, more than fifty different incisions are used - both longitudinal and transverse.

The extent of removal of fibrotic aponeurosis can also be different - from partial to total excision of tissue. It is technically impossible to completely remove the aponeurosis, the intervention is traumatic and does not guarantee the absence of relapse, therefore partial aponeurectomy is considered more preferable regardless of the volume, severity of the lesion and stage of the disease.

Conservative treatment of Dupuytren's contracture

Non-surgical treatment of hand tendon fibrosis is carried out by traumatologists and orthopedic doctors. Conservative methods are used only at an early stage of pathology; they are aimed at slowing down scarring and include:

• Physical therapy;
• Physiotherapeutic procedures;
• Fixation of fingers with removable splints;
• Drug blockades;
• Collagenase injections.

Special therapeutic exercises help stretch the palmar aponeurosis and reduce the degree of flexion contracture of the fingers. Gymnastics for the hand can be active and passive. To stretch the palm, patients use splints, which are worn at night and fix the fingers in an extended state.

Physiotherapy includes thermal procedures that improve local blood circulation and trophism. Applications of paraffin, ozokerite and medicinal mud, which have a warming effect, are shown. Electrophoresis with lidase, hyaluronidase, and iodine helps to partially resolve scar tissue and slow down fibrosis. Diadynamic currents and UHF are used.

If contracture is accompanied by persistent, poorly relieved pain, then medication is indicated. blockade with corticosteroid hormones (triamcinolone, diprospan), which are injected simultaneously with a local anesthetic into the area of ​​the painful fibrotic lesion.

The effect of such a blockade lasts one and a half to two months, after which the pain may resume again. Hormones should be used with caution due to the risk of side effects and remembering that only conservative treatment does not cure contracture, but brings temporary relief.

At home, the patient can carry out many procedures himself - apply paraffin, make hot baths for the hand, while actively moving his fingers in the water, massage the changed areas on the palmar surface.

collagenase injection

One of the new trends in conservative treatment of contracture changes in the hand is considered collagenase injections. This technique is common in many European countries and is beginning to be practiced in the post-Soviet space.

To slow down fibrosis, collagenase is used, an enzyme that can break down collagen fibers and slow down scarring. The drug is injected into subcutaneous fibrous nodes or thickened aponeurotic cord. During the day, the patient is prohibited from actively moving his hand and fingers.

On the second day after the first injection of collagenase, the patient again comes to the doctor, who carefully straightens his fingers. For the first 24 hours, any independent movements are strictly prohibited, as they can provoke the spread of the medicine into the surrounding tissues, which is fraught with swelling, inflammation and severe pain.

Usually the effect is noticeable after just one procedure - pain and the degree of contracture decrease, the range of active movements of the fingers increases. Less often, the patient requires repeated administration of collagenase, which is possible no earlier than a month after the first procedure.

The introduction of an enzyme preparation is effective in most patients, but the method cannot be considered absolutely harmless. It can cause side effects such as swelling, pain, and hematoma formation at the injection site. These phenomena usually disappear within two weeks.

No matter how effective the conservative method of treating Dupuytren's contracture may seem, it still does not eliminate the pathology, since the substrate in the form of a scarred aponeurosis remains on the hand, and every second patient returns to the doctor with a relapse.

With the progression of contracture, limited mobility of the fingers and the inability to perform professional or everyday tasks, the only possible method of treatment becomes surgery, which should be performed only by a specialist who has specialized in hand surgery and has experience working with such pathology. The intervention requires the highest level of knowledge of anatomy, extreme precision, careful selection of a rational method of skin incision and the volume of tissue excision.

Surgical treatment of Dupuytren's contracture

Surgical treatment of Dupuytren's contracture can be a palliative operation, in which fibrous adhesions are dissected, the fingers are returned to an extension or functionally advantageous position, but the aponeurosis itself is not removed, or a radical intervention.

In severe cases, radical treatment with total excision of all altered parts of the palmar aponeurosis is indicated. Radical and palliative approaches can be combined in advanced stages of the disease, when the scarring process is widespread on both the palm and the finger.

There are several types of surgical interventions for palmar contracture. The most common are:

1. Aponeurotomy (needle and open);
2. Aponeurectomy;
3. Dermoaponeurectomy;
4. Corrective arthrodesis;
5. Amputation of fingers;
6. Fixation with the Ilizarov apparatus.

Surgical treatment of Dupuytren's contracture is most often performed on an outpatient basis under local anesthesia. Before the operation, the patient undergoes standard examinations (blood and urine tests, coagulogram, fluorography, consultation with a therapist, testing for HIV, hepatitis, syphilis) and on the day of treatment comes to the surgeon with the results.

To prevent complications and improve visibility, the operated hand is bled by wrapping it with an elastic bandage, applying a tourniquet or a tonometer cuff. The skin of the hand is treated with an antiseptic. The surgeon uses magnifying optics.

Aponeurotomy is one of the non-radical operations usually indicated for elderly patients, but it can also be performed on young people. Aponeurotomy is very effective if strict indications for it are observed, which are:

• The only fibrous cord on the palm;
• The skin over the area of ​​fibrosis is healthy or minimally changed.

It makes no sense to perform an aponeurotomy in cases where the scar affects the finger and a persistent flexion contracture has formed.

During aponeurotomy, the surgeon makes several transverse dissections of the connective tissue cord under local anesthesia, on an outpatient basis. After the operation, a plaster cast is applied to fix the finger in a state of extension. Additional skin plastic surgery in combination with dissection of the scar on the hand helps to prolong the activity of the hand for many years.

needle aponeurotomy

Needle aponeurotomy - a minimally invasive method of combating pathology, in which the surgeon cuts through connective tissue bridges through several punctures of the skin with a needle. The operation has virtually no complications, recovery is very fast, but the likelihood of relapse is quite high.

Aponeurectomy - a radical method of treatment, and the operation itself is quite technically complex, requiring the surgeon to have experience and knowledge of possible complications during its implementation. To avoid negative consequences, the specialist must choose the right access, eliminate the possibility of damage to the nerve trunks of the hand and blood vessels, and perform plastic surgery of skin defects.

The difficulties of the operation are associated with the fact that in the postoperative period the skin over the scar contracts, so the access must ensure its lengthening. In addition, necrosis is common due to improper cutting of skin flaps during the intervention. The optimal access is linear along the fibrous cord followed by Z-shaped plasty.

The surgical technique includes a number of successive stages:

1. Designation of the skin incision line;
2. Isolation and excision of scar tissue, sections or the entire aponeurosis;
3. Careful hemostasis, finger extension;
4. Drainage application;
5. Removal of a tourniquet or cuff, coagulation of blood vessels, suturing of skin wounds;
6. Apply a pressure bandage and immobilize in a cast.

The radicality of aponeurectomy implies complete excision of fibrous tissue and adjacent zones of aponeurosis, as well as skin fragments involved in the scarring process. The operation begins from the top of the aponeurosis, which is carefully separated in the direction of the fingers, then the connective tissue adhesions in the palm are eliminated.

The most difficult stage of the operation is the excision of scars that have spread to the fingers, displaced and surrounded the digital vessels and nerves. At this moment, damage to the nerves of the hand may occur, which is one of the most common complications and is almost always a consequence of insufficient experience of the surgeon.

To prevent injury to the nerves, they should be recognized and isolated outside the scarring area and before removing the scar chords, for which microsurgical instruments and magnifying optics can be additionally used. If damage to the nerves could not be avoided, then they must be sutured according to all the rules of surgical technique on nerve fibers.

Damage to the vessels that supply the fingers is no less a problem in hand surgery. It is especially relevant when fibrosis spreads to both sides of the finger at once. In such technically difficult cases, the surgeon always uses an operating microscope to preserve at least one of the arteries of the finger.

If the arteries have been damaged, then in the postoperative period it is necessary to carry out conservative therapy to improve blood flow and microcirculation. If it is ineffective, angioplasty is performed.

In the postoperative period, spasm of the vascular branches is possible, which is aggravated by excessive extension of the fingers. After the operation, it is forbidden to place the hand in an elevated position, which provokes a decrease in blood circulation. Full extension of the fingers is achieved gradually over several days after the intervention.

An important point of radical surgery is the plastic surgery of skin defects on the palmar side of the hand. For this, both palmar flaps and skin fragments taken from the forearm can be used. To prevent necrotic complications, skin flaps should not be taut.

The technique of closing the wound after aponeurectomy is twofold: with a blind suture or the “open palm” method. The first method can cause excessive tissue tension, hematoma formation and necrosis. The “open palm” method does not have these disadvantages, since the incision along the distal groove of the palm is not completely sutured.

Dermoaponeurectomy - this is a type of operation in which skin that has undergone scar changes, connective tissue septa and skin ligaments are removed, after which the skin defect is compensated by a graft. If blood circulation in the surgical area is good, then healing will give a good aesthetic result, but the range of finger movements will decrease. This technique is possible in case of relapse of the disease, but does not guarantee the absence of new relapses.

Corrective arthrodesis indicated in advanced cases of Dupuytren's contracture and is considered a palliative method that helps improve the position of the affected finger on the hand. Most often, arthrodesis of the articulation of the metacarpal bone with the phalanx of the finger is performed, in which the articular ends of the bones are removed so that their remaining parts can be compared in the most favorable position for the finger. Arthrodesis can be combined with aponeurotomy and aponeurectomy.

The most radical, but also the most traumatic method of treating contracture can be considered amputation of a finger, which is carried out for advanced pathology and relapses. Typically, such an operation is insisted on by elderly patients who are not ready for long-term and more gentle treatment or do not see the point in it due to the end of their working career.

Application of the Ilizarov apparatus performed at the stage of preparation for surgical treatment to straighten a strongly bent finger. Slow abduction of the finger can give a good result and even soften the connective tissue cords, but in rare cases, necrosis of the skin of the palm is possible.

Video: treatment of Dupuytren's contracture - story on NTV channel

Postoperative period and recovery

Rehabilitation after surgery on the palmar aponeurosis is long, lasting one and a half to two months. Upon returning home, the joints of the hand, free from plaster, should be active, but you should not overload them. The patient may need help from family members, and it is better to temporarily postpone household chores.

On the first day after the intervention, the drainage is removed, the surgeon carefully monitors the condition of the soft tissues and the position of the fingers. By the end of the first week, the plaster is removed, the bandage is replaced, and physical therapy and therapeutic exercises begin. After 10-14 days, the sutures are removed and the bandage is removed.

Adequate recovery after excision of scar tissue is only possible with regular, daily exercise several times a day. They are started in cold water to reduce swelling and soreness. A few days after the sutures are removed, a fatty ointment (with calendula, rose hips, etc.) can be rubbed into the postoperative scar area to soften the tissue and reduce pain.

Between exercises and at night, your doctor may recommend using removable splints to hold your fingers straight or wearing a traction splint. They are used for a long time, up to several months, and are completely canceled only if there are no changes in the scar.

The period of incapacity for work is a month to a month and a half, during which you must strictly follow all the doctor’s recommendations, do the exercises yourself and strictly monitor the slightest changes in the hand.

Treatment after surgery is necessary not only to prevent early complications, but also to reduce the likelihood of recurrence of Dupuytrn's contracture years later. As practice shows, almost half of patients experience repeated scarring in the same place or other areas of the tendons after a long time, but the more active gymnastics and physical therapy were carried out, the higher the likelihood of a favorable outcome.

In general, according to patient reviews, surgery for Dupuytren's contracture is well tolerated, but postoperative recovery cannot be called simple, since it requires some effort on the part of the person operated on and is quite lengthy.

Drug treatment does not eliminate the disease, but only postpones the operation for some time, so if it does not have a positive effect or worsens the scarring, you should not delay a visit to the surgeon, because the loss of time will make the operation more traumatic and extensive.

The reasons for the development of Dupuytren's contracture have not yet been established. Over time, the palmar tendons degenerate and scars form, which negatively affects the functioning of the entire palm. When diagnosing, shortening of the tendons, limited extension of one or more fingers, and the development of flexion contracture are revealed. A dense, knotty cord forms in the affected area, resembling a large dry callus. At the initial stage of the pathology, there is a slight limitation in finger extension. In the absence of medical intervention, its stiffness develops, and then complete immobility.

Appearance of the affected hand.

Treatment of Dupuytren's contracture at home involves taking measures that accelerate the resorption of scars and increase the range of motion in the affected joint. For this purpose, rubbing, ointments, baths with essential oils, massage, and applications are used.

Drug therapy

If it is discovered that part of the tendon has been replaced by rough fibrous tissue, surgery is performed in most cases. But if the patient notices the first symptoms of the development of Dupuytren’s contracture in time, then treatment is carried out using conservative methods. Taking pharmacological drugs is not practiced, only sometimes the following are prescribed to relieve pain: Ibuprofen, Nise, Ketorol. Also rarely, injection solutions of glucocorticosteroids (Dexamethasone, Diprospan) are injected into the tendon. Dupuytren's contracture, or palmar fibromatosis, is not an inflammatory pathology. Therefore, hormonal drugs are used for persistent pain that NSAIDs cannot eliminate.

• Lidase;
• Trypsin;
• Ronidase.

Drugs produced in powder form are mixed with an isotonic sodium chloride solution. Then a sterile napkin is moistened in it and applied to the affected tendon. The bandage is covered with plastic film and secured with a bandage. The duration of the treatment procedure is from 1 to 3 hours. Proteolytic enzymes soften fibrous tissue, improving finger flexion and extension.

Relatively recently, the drug Xiaflex appeared on the market, the use of which is considered a worthy alternative to surgery. Its active ingredient is collagenase. This is an enzyme that destroys peptide bonds of pathological collagen. Xiaflex is intended for injection directly into the tendon.

Massage and therapeutic exercises

Massage and regular performance of special exercises help increase the elasticity of the tendon and improve finger flexion. Traumatologists and orthopedists recommend combining these treatment procedures. For massage, cosmetic or vegetable oils are used: olive, linseed, almond, wheat germ and apricot kernels. Sometimes concentrated sea buckthorn oil is used, but its coloring effect on the epidermis should be taken into account. Apply natural products in a thin layer over the entire palm and begin to rub them into the skin in smooth circular movements. After blood circulation has improved, move on to the area of ​​the affected tendon:

• apply a little more oil and massage the fibrous areas, phalanges, bases of the fingers;
• Lightly tap the skin and perform smoothing movements.

During the procedure, minor discomfort may occur. But if severe pain occurs, the massage should be stopped. Correct execution of all manipulations helps improve the flexion function of the finger. Therefore, it’s time to perform therapeutic exercises. Exercise therapy doctors recommend listening to the sensations that arise during exercise. If rotation of the palms leads to an increase in the range of motion in the joints, then such exercises should be repeated daily 50-80 times in several approaches. The same applies to flexion and extension of the fingers, and then the fists.

Pharmacies and medical equipment stores sell very useful devices - soft expanders, rubber or plastic balls with spikes. They are designed to strengthen the ligamentous-muscular system of the hand. You can squeeze and unclench expanders or balls while watching TV, reading a book, or working at the computer.

Physiotherapeutic procedures at home

In the treatment of Dupuytren's contracture, physiotherapeutic measures are actively used: shock wave therapy, electrophoresis, magnetic therapy, laser therapy. The procedures improve the blood supply to the tendon with nutrients and bioactive substances and help soften fibrous formations. Applications at home help enhance therapeutic activity. What can be applied to a sore tendon:

• clay - blue, green, red. The product is produced in the form of a powder, into which liquid is added in parts until a viscous, thick mixture is formed. It is evenly distributed over the affected area, covered with cellophane film, secured with a bandage and left for 1-2 hours. Clay is diluted with vegetable or cosmetic oils, low-fat kefir, and mineral water. To provide a warming and analgesic effect, add 2-3 drops of fir or pine essential oil while mixing;
• ozokerite or paraffin. Applications with these compounds have a powerful warming effect, which has a positive effect on joint mobility and microcirculation. Ozokerite and paraffin are sold in the form of dry mixtures, which are melted in a water bath. Then cool to a comfortable temperature, apply 5-10 layers to the tendon with a wide brush and leave for 1-3 hours.

Applications with bischofite, a natural mineral consisting of a chloride-sodium-magnesium complex, accelerate metabolism and increase the elasticity of the tendon. It also contains bromine, iodine, iron and other trace elements necessary for joints. In pharmacies, bischofite is sold in liquid dosage form, ready for use. A sterile napkin is moistened in it and placed on the sore tendon until completely dry. Bishofite is added to warm water in a ratio of 1:5 and hands are kept in it for 30-45 minutes. These baths are suitable for daily use.

Homemade rubs and ointments

One of the most effective methods of treating Dupuytren's contracture with folk remedies is rubbing and ointments. Their therapeutic effect is based on warming and softening the tendon, improving flexion and extension of the fingers. Traditional healers recommend preparing rubs according to the following recipes:

• 10-15 horse chestnut fruits are peeled and crushed. The resulting pieces are placed in a dark glass container with a volume of 0.5 liters and filled up to the neck with vodka or 96% ethyl alcohol. Place the dishes in a dark place for 1-2 months, shake thoroughly every day. Rub into the affected tendon 2-3 times a day. For those with dry and sensitive skin, it is better to dilute the tincture with a little water before use;
• 3-4 young fresh horseradish roots are peeled, crushed and placed in a 1 liter opaque container. Add a couple of large horseradish leaves, cut into strips 1-2 cm wide. Tamp, pour alcohol or vodka so that the liquid only covers the plant material. The container is kept in a dark place at room temperature for 1-2 months, shaken often for better extraction of beneficial substances. Rub into the affected tendon 1-2 times a day;
• In spring or early summer, young large leaves of stinging nettle are harvested. Fill, tamp, an opaque container of any size, and carefully pour in vegetable oil along the wall. In the treatment of pathologies of the musculoskeletal system, flaxseed and olive oils are considered the most useful. Regular sunflower oil will also work. Leave it in a dark place for a couple of months, rub it into the tendons and joints several times a day. The longer the nettle is in the oil, the more healing the rubbing becomes.

Homemade ointments are also used in the treatment of Dupuytren's contracture. The most effective is considered to be a product containing gum turpentine. 50 g of thick honey, natural butter and medical Vaseline are placed in a mortar. Rub thoroughly, adding 3 drops of essential oils of rosemary, fir, pine, a tablespoon of turpentine and almond cosmetic oil. The aromatic mass is transferred to a jar and stored in the refrigerator. Rub into the tendon 2 to 5 times a day.

Therapeutic compresses

In folk medicine, compresses are actively used to eliminate the symptoms of Dupuytren's contracture. A sterile bandage folded in several layers is impregnated with the prepared mixtures and applied to the area of ​​the damaged tendon. Cover with plastic wrap and secure with thick cloth. The duration of the procedure is from 2 to 5 hours. Traditional healers advise keeping the compress on all night if it does not negatively affect the quality of sleep. In the treatment of palmar fibromatosis (often called “chicken foot”), the following compress mixtures are used:

• mix 30 g of thick honey and vodka in a mortar, adding a drop of juniper, rosemary and mint oil;
• 3 tbsp. spoons of dry sage are brewed with a glass of boiling water and left for an hour. Strain and dissolve a tablespoon of sea salt;
• Brew a tablespoon of chamomile with 0.5 cups of boiling water and leave for a couple of hours. Filter, add 3 tbsp. spoons of wheat germ cosmetic oil. Shake the emulsion thoroughly before use.

Compresses made from fresh plant materials have a warming effect and improve blood circulation in the tendon. From the leaves of horseradish, cabbage, and plantain, cut into pieces of suitable size and lightly knead them. Thick honey is applied, applied to the diseased tendon, covered with a film, and fixed with an elastic bandage or adhesive plaster. The duration of the treatment procedure is 1-3 hours. Dry heating is also used to treat contracture. They help eliminate pain and enhance the effect of pharmaceuticals and other folk remedies. A linen bag with ties is filled with heated sea salt or flaxseeds and applied to the tendon and joints of the fingers for 30-40 minutes.

Healthy drinks

Experts in official and traditional medicine recommend consuming large amounts of fluid in the treatment of any diseases of the ligamentous-tendon system. Drinking plenty of fluids helps speed up metabolic processes and eliminate toxins and toxic compounds. It has a positive effect on overall health and helps to mobilize in the fight against pathology. It is useful for patients with Dupuytren's contracture to drink a lot of clean water, unsalted table mineral water, vegetable and fruit juices. The following drinks also have a general strengthening and tonic effect:

• Squeeze juice out of a glass of fresh or frozen cranberries and pour into a separate bowl. To the dry residue add 0.5 liters of hot water and 3-4 tbsp. spoons of sugar, simmer over low heat for 3-5 minutes. Cool, filter, mix with juice and take 0.3 cups 2-3 times a day after meals;
• bring a glass of milk to a boil, add a pinch of propolis, keep on fire for another 10 minutes. Cool, add a tablespoon of honey, drink throughout the day.

Green tea with oregano, lemon balm, and sage helps improve your well-being. Honey, wild berries, and chopped fruits are added to the hot infusion to taste.

Treatment of Dupuytren's contracture at home is effective only for grade 1 severity of the disease, when minor changes have occurred in the tendon. The most effective way to defeat pathology is surgery with excision of fibrous areas.

Dupuytren's contracture (other names: palmar fibromatosis, French disease) is scar deformation, tightening of the tendons of the fingers, as a result of which the fingers are bent and fixed in an unnatural position at a certain angle to the palm, and their extension becomes impossible. Leathery nodules form on the palms. The tendons of the ring and little fingers of the right hand are most often affected, although the process often affects both hands. Deformation leads to loss of basic functions of the hand.

In most cases, the disease affects middle-aged and elderly men (from 40 to 60 years), although women can also get sick.

In the presence of pathology, damage may occur:

• palm surfaces of one or both hands;
• fascia of the foot;
• interphalangeal joints of the hands;
• cavernous bodies of the penis

The disease can occur under the influence of certain factors or be inherited.

Stages of the disease

In its development, the disease goes through four stages:

1. The first is characterized by the appearance of cords and nodules on the palm, the fingers move freely.
2. At the second stage, the fingers are bent relative to the palm at an angle of 30 degrees and pulled together with cords.
3. When the disease passes into the third stage, the bend angle of the fingers is already about 90 degrees, which leads to a significant limitation in the functionality of the hand.
4. At the last (fourth stage), the fingers are almost pressed against the palm or take a hook-like shape, and the ability to extend is completely lost. The pathological process progresses and spreads to the entire tendon apparatus and articular structures.

Causes of pathology

There is still no reliable data on all possible causes of the disease.

Research shows the presence of a hereditary factor. The triggering gene is not located specifically on the X or Y sex chromosomes, but on one of the 44 chromosomes. As a result, the disease is transmitted with some sexual restriction and in most cases affects men.

There are several possible causes for the development of Dupuytren's contracture:

• injuries to the fingers or hand;
• pinching of the nerves going to the fingers or hand (neurogenic nature of the deformity);
• the presence of a congenital defect in the structure of connective tissue;
• disruption of the endocrine system;
• excessive physical stress on the hand;
• the presence of an inflammatory process in the ligamentous apparatus.

There is an opinion that the pathology is not characteristic of the hand individually, but of the entire connective tissue: the hands are the most common location of the disease.

The following factors create a favorable background for the development of the disease:

• alcoholism;
• smoking;
• epilepsy;
• diabetes;
• genetic predisposition;
• age over 40 years;
• metabolic disorders;
• the presence of a focus of inflammation;
• violation of trophism of the hands;
• pinched nerves in the elbow joint.

Manifestations of Dupuytren's contracture

In normal condition, the hand is fully flexed and extended. In Dupuytren's disease, the ligament of the fingers (or one finger) shrinks, making full extension impossible. Movement in joints affected by the pathological process is limited, often to the point of complete immobility. With such a course of the disease, fusion of the articular surfaces and the formation of ankylosis occurs.

Nodes, most often painful, form in the projections of the tendons on the surface of the palms.

Depending on the location of the lesion, contracture is divided into three types:

• palmar;
• finger;
• mixed.

The first stage of the disease is characterized by the presence of the following symptoms:

• appearance of subcutaneous lumps in the palm area;
• fingers are almost unlimited in movement;
• the changes that have occurred do not yet disrupt the normal course of life;
• no significant cosmetic defects are observed.

At the second stage, the following signs appear:

• slight limitation of extension movements - maximum 30 degrees;
• initial limitations of hand functions;
• pain syndrome is usually absent;
• The operation gives a pronounced full effect.

Characteristic symptoms of the third stage are:

• defect in extension of the affected fingers (30-90 degrees);
• the sore finger is always bent;
• severe pain in the hand area;
• significant dysfunction of the hand;
• surgical intervention does not always lead to the desired result: in some cases, extension may remain limited.

At the fourth stage of the disease, the following processes occur:

• the pathology extends to the joints and tendons;
• changes in the fingers become pronounced and persistent;
• contractures (articular surfaces) grow together;
• reduction in the ability to extend the finger more than 90 degrees (in other words, the finger does not actually extend);
• severe deformation and loss of hand function;
• Surgical intervention practically does not produce results - often there is a need for several complex operations.

Diagnosis and treatment

To make a diagnosis, the patient is interviewed to find out how long ago the symptoms have been onset, and the degree of influence of the pathology on the quality of life is clarified.

To detect the causes of pathology, it is important to find out about the presence or absence of the disease in any of the close relatives, to find out whether the patient smokes, as well as his attitude to alcoholic beverages.

A thorough examination of the hand is carried out and the degree of mobility of the fingers is determined.

During the examination, a certain position of the fifth finger is visually detected: the little finger can bend at the first interphalangeal joint and is located at right angles to the main phalanx. In the area of ​​the distal palmar fold, the presence of tuberosity of the skin is noted.

By palpation, compactions of the palmar fascia in the form of dense nodules can be easily determined.

At the first stage, the nodules are located in the palm area; as the disease progresses, they are localized in the area of ​​the fingers.

The amplitude of flexion and extension of the fingers is specified. In the presence of this pathology, the extensor capabilities of one or more fingers are noticeably reduced. In case of severe pathology, at its last stage, it becomes impossible to straighten the fingers.

The stage of the disease is determined by the degree of mobility of the fingers.

As a rule, there is no need for additional diagnostic tests and laboratory studies.

It is possible to carry out differential diagnosis to exclude contractures of a traumatic, neurogenic, ischemic or rheumatoid nature, since contracture can develop as a result of an injury, an open fracture, damage to tendons, muscles, or gunshot wounds.

Treatment of Dupuytren's contracture is the task of an orthopedic doctor.

The disease is treated in two ways: conservative and surgical.

The specific method is selected depending on the duration and severity of the disease, the degree of limitation of the functions of the hand, the mobility of the joints, the changes that have occurred in them, the extent of the spread of the pathological process and the general condition of the surrounding tissues.

The main methods of conservative therapy are:

• thermal physiotherapeutic procedures – ozokerite, paraffin;
• therapeutic exercises aimed at stretching tendons;
• in the most extended state - applying a splint (during sleep);
• electrophoresis,
• exposure to ultrasound;
• corticosteroid injections;
• blockade using local anesthetics with hormones.

The goal of conservative methods is to slow the progression of the disease. They cannot stop the process. To completely get rid of the disease, surgery is required.

The main surgical methods are needle aponeurotomy and arthrodesis.

The essence of aponeurotomy is to remove nodules using special needles.

The indication for surgery is that the finger reaches a flexion angle limited to 30 degrees. Complete or partial excision of the tendinous fascia and pathological cords is performed.

If there are significant changes, arthrodesis is advisable. As a result of this type of surgery, the finger is straightened, but the joint remains motionless.

Very severe cases, in which there is a strong proliferation of connective tissue and damage to blood vessels and nerves, may require extreme measures - amputation of the finger.

The surgical intervention is performed under general anesthesia (i.e. the hand is numbed) on an outpatient basis. After a few hours, the patient can return home.

After open operations, dressings are performed for 14 days. Constant supervision of the attending physician is required.

After the postoperative wounds have healed and the sutures have been removed, the bandages are removed.

On the third day after surgery, an extensor functional splint is applied. The goal is to fix the fingers in the correct position.

Physiotherapeutic procedures occupy an important place in rehabilitation.

Before removing the sutures, magnetic laser therapy is performed, followed by phonophoresis and electrophoresis with hydrocortisone.

Daily physical therapy is also necessary.

Currently, joint diseases are among the most common diseases.

Unfortunately, quite often you can encounter a disease such as Dupuytren's contracture, when bending the joint causes severe pain or is completely impossible.

Externally, the disease can manifest itself as hardness and the formation of nodules. Such signs contribute to scarring and subsequently lead to the inability to bend the fingers.

This disease, Dupuytren's contracture, is popularly called "French disease". It appears as a lump on the hand and develops over a long period of time.

To avoid such serious consequences of this disease, it will be very useful to consider possible home treatment options for Dupuytren's contracture.

Description of the disease

Dupuytren's contracture (palmar fibromatosis) is a condition in which the tissue on the palms that covers the fingers and tendons can become thick and scarred. Its ICD-10 (International Classification of Diseases) code is M72.0.

The affected tissue, which experts call the palmar fascia, becomes increasingly stiff and wrinkles over time. As a result, the fingers bend inward towards the palm.

The progression of the disease usually occurs over many months, although in very rare cases the disease may appear suddenly.

Palmar fibromatosis can affect absolutely any fingers, but most often it affects the little or ring finger. In very rare cases, the disease affects the index fingers and thumbs.

In addition, palmar fibromatosis can affect either one or both hands.

Dupuytren's contracture: what to do when knots appear on the palm and the fingers do not straighten?

Although Dupuytren's contracture has recently become an increasingly common condition, its causes are still not fully understood.

An interesting fact is that men, in most cases of mature age, most often suffer from this disease. Older men over 60 years of age are most at risk of getting sick..

By the way, palmar fibromatosis is often inherited.

The most common causes of Dupuytren's contracture include:

• epilepsy;
• diabetes mellitus (type 1, type 2);
• problems with the thyroid gland;
• smoking is one of the most likely causes of the disease;
• work in production;
• alcohol abuse (especially if the liver is seriously damaged);
• the use of anti-epileptic drugs can also trigger the development of the disease.

Characteristic symptoms of palmar fibromatosis

Dupuytren's disease progresses at a slow pace. One of the first symptoms that is detected upon visual examination is thickening of the skin on the fingers (or palms).

The skin begins to wrinkle a little, the patient notices how dimples or hard bumps appear, very similar to wen. These bumps can be felt when touched, but they do not cause pain.

As the disease progresses, dense and rather thick nodules form under the skin. The thicker these nodes become and enlarge, the more the fingers stop extending, typically remaining bent inward of the palm.

1. Proliferative phase- This is the phase during which the nodule begins to develop. At the onset of the disease, patients feel discomfort, less often pain. Painful manifestations are the result of nerve endings penetrating fibrous tissue or simply due to pinched nerves. During a visual examination, the pallor of the skin on the hands is clearly visible.
2. Involutional phase- the disease begins to spread deep into the tissues and thickened longitudinal nodes form.
3. Residual phase- the disease continues to progress and penetrate the tissue, the node or nodes become denser, and contractures begin to form.

It’s sad, but in most cases, patients turn to doctors for help too late, already in the case of the development of significant contractures, as well as with disruption of the hand.

Therefore, treatment of Dupuytren's contracture without surgery may be effective only in the initial stages of the disease. These methods include physiotherapy, exercise therapy, massage and other special exercises for Dupuytren's contracture.

In the absence of inflammation, stretching exercises for the muscles of the palm can be very helpful. It is recommended to use splint bandages at night.

But in most cases, doctors prescribe therapy with medications. For example, for local inflammation, injections of certain corticosteroid drugs should be performed.

Also, in the early stages, doctors prescribe paraffin treatment, injections of the vitreous body, plasmol, papain, applications of ozokerite, sage, acupuncture, mud therapy, which makes it possible to stop the progression of contractures, albeit for a short time.

In addition, for contracture, applications of proteolytic enzymes to the affected area are widely used - injections with lidase, ronidase, trypsin and others, the function of which is to activate all metabolic processes in connective tissues, soften scar tissue and slow down degeneration.

In addition to these techniques, many resort to treatment with ointments and gels based on homeopathy. Others like the effect of using the drug Conractubex.

Contractubex is a combined external preparation with proteolytic activity, which is used for the resorption of scars, namely keloids.

Treatment with Vitafon, a painless procedure using shock wave therapy, has proven to be quite effective. During this process, the device generates a wave that is directed directly to the source of the disease. This effect can cause positive changes in connective tissue.

Sometimes experts recommend forming a fixed joint in order to immobilize the fingers. In exceptional cases, if the connective tissue has grown and it leads to pinching of blood vessels and nerves, it is recommended to amputate the finger.

What to do if your fingers don't straighten

At the initial stage of the disease, you can and even should try to treat it with traditional methods. The most popular of them are rubbing, baths, compresses, heating and various herbal infusions.

Chestnut mixture for grinding. To prepare it you will need from 200 to 400 grams of chestnuts and half a liter of vodka. First, peel the hard chestnuts, chop them thoroughly with a regular fork or mortar, pour 500 ml of 40% vodka over the chestnut pieces.

The resulting solution should be infused for one or two weeks in a dark and cool place. Then you need to strain the infusion using a gauze napkin and rub the medicinal mixture on the affected areas of your hands before going to bed.

In order to avoid allergies, first apply the tincture to a small area of ​​the body, for example, on the wrist, and after half an hour, make sure that there is no redness or inflammation.

Kerosene infusion. To prepare a healing tincture, you need to prepare one glass of kerosene, a glass of sunflower oil and about five red hot peppers.

Grind the pepper pods in a meat grinder and mix them with kerosene and oil. Infuse this solution in a dark, warm place for 8-9 days, but do not forget to stir it daily.

After this time, strain the solution using a gauze pad and you can rub it into the affected areas with massaging movements.

After this, apply gauze bandages to the painful areas, or wool ones if you are not allergic to wool.

Important: if pepper causes allergic reactions in you, this infusion is not suitable for you, as there is a risk of developing hives.

. To prepare this medicine, you need to prepare one mature, dense aloe leaf.

To squeeze out as much juice as possible, lightly press the leaf, and then you can begin to lubricate the affected areas of the skin with it. It will be very useful to leave aloe juice on sore spots for a short period of time (20-30 minutes).

Healing decoction of pine needles. Prepare one bunch of pine needles or cones with resin, cotton wool or a cotton pad. First, place a bunch of pine needles or a cone in one glass of warm water (the total weight should be approximately 100-150 grams).

Next, pour boiling water over the needles and leave for one day. Then take a small piece of cotton wool or a round cotton pad and dip this kind of tampon into a decoction of pine needles and apply such a compress to the affected areas for 10-15 minutes.

Treatment of contracture with an expander. An expander is a small sports device designed specifically for the hands. Doctors recommend using it regularly; 8 to 10 approaches of at least 10-20 compressions should be performed per day.

Important: if you experience pain when squeezing your hands, then the expander is not suitable for you, so you can safely refuse this method of treatment.

Therapeutic potato baths. To prepare this product you will need potato peelings (about 5-7 potatoes), 1 beet, 1 carrot, 1 onion.

Pour about 4-5 liters of water into a large saucepan, add potato peelings and other vegetables, 1 tablespoon of salt and 20 drops of iodine. This product needs to be simmered over low heat for about 40 minutes.

After this time, remove the pan from the heat and leave to cool. Then, when the temperature of the broth is about 30-40 degrees, lower the affected limbs into a pan with the broth for 7-15 minutes. Try to open and close your hands in the water.

. Massage with olive or butter has proven itself to be one of the most effective methods for this disease.

It is most beneficial to use natural homemade oil, but if you don’t have one, you can use store-bought oil. Using light circular movements, first massage your fingers for about 5 minutes, then your palm.

Important: do not press too hard on your palms, as this can cause severe pain.

However, it will bring benefits only if it is used constantly - from 5 to 7 times a day, especially do not forget to lubricate your palms with cream at night.

Oral remedies for contracture

Chestnut tincture, which is prescribed for internal use, has won a large number of positive reviews.

To prepare it, chestnut flowers are infused with vodka, in the ratio: one small handful of flowers per half liter of vodka, for two weeks in a dark, cool place. After this time, the infusion should be carefully filtered and taken 30 drops 3-4 times a day.

According to numerous testimonies from patients, oat tincture also gives an excellent effect, but only with long-term use (at least a year).

To prepare it, you need to pour a glass of grains with a liter of clean water and leave for 10 hours.

After this time, it is necessary to boil the solution, let it settle again, add water to one liter and take 100 ml 3 times a day for 45 days. This is followed by a month break, and after that it is recommended to repeat the course of treatment.

With Dupuytren's contracture, it is necessary to completely eliminate alcohol, strong coffee, bread and other high-carbon foods, since such a diet gives a good result to maintain treatment.

As an option, you can try the “Stone Age Diet” or otherwise called the “Paleolithic Diet”. Here's what it includes:

• nuts and seeds;
• eggs;
• olive and coconut oils;
• fresh vegetables and fruits;
• meat;
• water at least 1.5 liters per day.

Products to exclude:

• refined sugar;
• dairy products;
• potato;
• refined vegetable oils such as rapeseed;
• salt;
• cereals;
• legumes

The level of iodine and magnesium should be normalized. It is also good to supplement your diet with vitamins D and probiotics.

This diet should be carefully monitored by specialists, so be sure to consult your doctor.

After surgery, you should raise your arm to avoid swelling, and lubricate the suture with a special ointment for speedy healing.

After a few weeks, doctors prescribe warm baths, regular lubrication of hands with rich cream and massages.

Treatment after surgery for Dupuytren's contracture is often based on folk recipes. Numerous reviews have confirmed the effectiveness of these methods not only to slow down, but even to stop the development of the disease.

However, when treating contracture with traditional recipes, you will need maximum care and the ability to allocate time for procedures.

After surgery, the following are most often prescribed:

• baths;
• rubbing;
• compresses.

The bath using peelings of potatoes, carrots, onions and beets has gained the most popularity. Her recipe is described in detail in the article above.

Specialists who work with patients with Dupuytren's contracture every day notice that the relapse rate is very high. Even after a full course of treatment, symptoms of the disease may return.

Therefore, it is very important to apply all the advice and prescriptions of your doctor, take care of your diet and often be on the move.

The good news is that Dupuytren's contracture is a virtually painless disease, and the vast majority of patients who seek help promptly recover.