Treatment of Dupuytren's conjuncture without surgery. Causes and mechanism of development. How helpful are conservative methods?

The disease known as Dupuytren's contracture is a pathological process characterized by the occurrence of scar degeneration in the area where the palmar tendons are located, which provokes shortening of the latter and leads to disruption or even complete loss of flexion function, i.e. the patient loses the ability to straighten his fingers normally. In parallel, the appearance of nodular skin compacted formations on the affected palms is noted.

In the following narrative, we will talk about the causes of such a disease as Dupuytren's contracture and the features of its treatment.

Dupuytren's contracture in the photo

Video - Dupuytren's Contracture. What makes your fingers curl?

The exact reasons that provoke the development of contracture have not been determined. Along with this, many representatives medical field are of the opinion that the disease develops with high frequency in patients with epilepsy, diabetes mellitus, and also in chronic alcoholics.

The pathology is prone to hereditary transmission. However, not in all cases, children of patients with Dupuytren's contracture inherit the disease gene. In accordance with average statistical data, the disease is most often diagnosed in male patients.

Contracture can be inherited

In the medical literature you can find information according to which the disease develops against the background of constant physical overload of the hands. Along with this, not every person involved in heavy physical labor, contracture occurs.

To a certain extent, the likelihood of developing pathological process increases in the presence of the following provoking factors:

• violations of internal metabolic processes arising against the background of pathologies thyroid gland, hidden diabetes mellitus, etc.;
• diseases of the inflammatory group;
• pinched nerves of various origins;
• various infectious processes in organism.

Making the situation worse various kinds hereditary syndromes, neuropathy, as well as chronic trauma.

Symptoms and features of the disease

Among characteristic features of the disease being studied, the following points can be noted:

• the appearance of compactions and nodules localized on the skin of the affected palms;
• the appearance of subcutaneous cords prone to slow gradual compaction;
• loss of the ability to freely and fully extend the fingers;
• decrease in normal sensitivity of the fingers (noted with advanced contracture).

Important note! Dupuytren's contracture has a number of similar symptoms with various tumors of the hands and tenosynovitis (inflammatory processes affecting the tendons). That is why during the diagnosis, appropriate actions will be taken to differentiate the disease from similar pathologies.

As for the characteristics of the course of contracture, as it develops, the palmar aponeurosis undergoes processes of cicatricial degeneration. The mentioned element is a subcutaneous plate localized on the hands and consisting of connective tissue. In accordance with the intensity of symptoms and the overall severity of the pathology, it is classified into several degrees. About them in the table.

Table. Degrees of contracture

Dupuytren's contracture - stages

Possible complications and prognosis

If the disease is not treated, a number of complications will arise. Firstly, the joints will “freeze”, accompanied by complete immobility of the fingers. Secondly, the fingers will lose their sensitivity - the process is characterized by irreversibility.

The forecasts, provided that the disease is detected in a timely manner and actions are taken to eliminate it, are optimistic. At grades 1-2, the functions of the hand and fingers, as a rule, can be completely restored.

Diagnosis procedure

Diagnostics of this disease falls within the competence of the orthopedist. Having studied the patient's complaints and carried out visual inspection, the doctor will ask the necessary clarifying questions, perform palpation, and evaluate the mobility of the fingers and the hand itself.

In most situations, it is not necessary to resort to the use of laboratory and instrumental techniques. Otherwise, the decision for a specific case remains with the treating specialist.

Conservative treatment options

Conservative methods can alleviate the patient's condition initial stages contractures. The following methods are actively practiced:

Subject to local availability inflammatory processes, corticosteroid injections may be prescribed.

It is important to understand that existing conservative methods help to slow down the progression of the pathological process and allow partial restoration of the functions of the affected areas, but after a certain time it will definitely be necessary to resort to surgical intervention. At the same time, young patients are likely to have to undergo several such operations throughout their lives - contracture is prone to recurrence after a few years or after a longer period.

Surgical intervention

Surgical intervention is traditionally resorted to if the pathological process has led to bending of the fingers to 30 degrees or more. As noted, operated on severe contracture in young patients is prone to relapses, requiring repeated surgical intervention.

The main task of the operation is to excise the formed fibrous cords, as well as the palmar fascia. As a result, positive changes occur that help restore the function of the affected fingers.

One of the most commonly used methods of surgical intervention is aponeurectomy - a rather complex manipulation that requires the performer to have relevant experience and high qualifications. During an aponeurectomy, the following should be done:

• selected correct method surgical access;
• the affected tissues are completely removed;
• actions have been taken to eliminate the risk of damage to the nerves of the injured hand;
• blood supply to sore fingers is restored;
• formed skin defects are removed;
• failures excluded internal blood supply in the treated areas;
• actions have been taken to eliminate the risk of hematomas;
• selected best method closing the wound.

Depending on the individual characteristics patient's condition, surgical intervention can be carried out under general anesthesia or anesthesia. The palms are prepared for treatment using special enzyme enzymes. medicines and physiotherapeutic techniques. In the absence of such preparation, during the operation there will be difficulties in separating the skin and scar formations.

If the preparation and the actual surgical intervention were performed according to the rules, there is usually no need for skin excision and subsequent reconstructive plastic surgery. During rehabilitation period methods of functional therapeutic influence, electrotherapy, massage and other manipulations are used at the discretion of the doctor.

After completing a rehabilitation course, the function of the affected areas is restored and the patient is able to return to full life.

Contracture is treated comprehensively

Video - Dupuytren's contracture treatment

Belongs to the group of the most common clinical pathologies. You can often find such a joint disease when flexion and extension of the fingers causes painful discomfort, and sometimes completely impossible.

In medicine, this pathology is defined as Dupuytren's contracture. Treatment without surgery joint disease is possible only at the initial stage of development of the disease, when the first signs of joint pathology appear.

Description of the disease

Contracture, translated from Latin language, means narrowing or contraction, that is, a condition when the joint cannot fully perform a passive action, bend or straighten.

There is a non-inflammatory process when cicatricial degeneration of the palmar tendons occurs, medically defined as palmar fibromatosis, or Dupuytren's contracture, named after the French military surgeon Guillaume Dupuytren (1777-1835).

It was he, the life surgeon of Louis XVIII, who first described in detail the method of surgical treatment (aponeurotomy) of this proliferative disease of the connective tissues of the joints.

The cause of joint contracture is not fully understood. According to the study, men after 45-50 years of age are most often susceptible to palmar fibromatosis. This disease is rare in women. The most affected area is ring finger hands.

If the pathology is not stopped in time, then “ chain reaction", involving in the affected area middle finger, and then the little finger. Dupuytren's contracture does not affect the thumb and index finger.

There are several versions of the origin of this disease, which do not have sufficient argumentation, since practically no one in the world really deals with this problem.

Guillaume Dupuytren himself, describing the disease, believed that “contracture develops as a result of prolonged compression of the fulcrum in the hand.” Limitation of flexion or extension of a particular joint is due to mechanical injury fingers Due to damage to connective tissues, insufficient nutrition occurs, which creates conditions for degenerative-dystrophic dysfunction. Opponents of G. Dupuytren’s theory believe that neurogenic transformations in connective tissues caused by pathology in the periphery are to blame nervous system, in particular, ulnar nerve neuritis.

Other medical experts are inclined to believe that the cause-and-effect relationship for the development of palmar fibromatosis is.

However, the most popular version remains the opinion about the tumor-like nature of Dupuytren's contracture, associated with the development of the expressive oncogene C-myc in the cellular structure. A hereditary form of the disease cannot be excluded.

Signs and symptoms of Dupuytren's contracture

The initial stage of fibromatosis of the palm begins with a nodular compaction on the pad under the main phalanx of the affected finger. The tubercle may initially cause pain or not cause much discomfort, manifesting itself as periodic itching in the affected area.

As the disease progresses, the range motor activity the affected finger becomes limited. The development of Dupuytren's contracture is divided into three stages, or phases, of the joint disease.

Test and install preliminary diagnosis Just. If you find a suspicious bump on your ring finger, you must place your palm on a flat, smooth surface, such as a table, and if a pencil or ballpoint pen passes freely through the space between the table and the bend of the main and middle phalanx, it’s time to consult a doctor.

As a test, you can check how quickly and painlessly your fingers bend and straighten.

The first sign of contracture is wrinkling of the skin of the palm.

How to treat contracture

With fully developed Dupuytren's disease (contracture) treatment without surgery is impossible. Limitation of joint mobility of a finger significantly affects a person’s quality of life. It becomes difficult to carry out simple steps when you need to firmly grasp an object with your palm.

A calming factor is the slow progression of the disease. It is human inaction that leads to severe disease, when surgical intervention is required. The final formation of contracture does not occur suddenly or immediately. The disease can be recognized in the initial phase of clinical pathology.

Surgical correction is still inevitable, but when it will be carried out depends on the person himself. For some, aponeurotomy is performed after 1.5-2 years, when the contracture of the bend of the finger reaches an angle of 30º, while for others this procedure may occur in old age.

Non-surgical methods

Conservative therapy at the initial stage of the disease involves physical treatment with thermal procedures (electrophoresis, heating with paraffin), high-frequency electron beam radiation (UHF) and special therapeutic exercises for the fingers, aimed at stretching the palmar aponeurosis.

The patient will be offered the use of a corrective splint, which will fix the finger in the extension position. This orthopedic device is worn at night and removed in the morning.

Therapeutic blockades are very effective in preventing cicatricial contractions. Among the most effective drugs:

• Diprospan® from the commercial manufacturer of the Belgian company SCHERING-PLOUGH LABO N.V.;
• Hydrocortisone® is produced by the chemical and pharmaceutical plant AKRIKHIN JSC (Russia).

These medications mixed with and injected into the painful node. The effect of this treatment lasts no more than 1.5-2 months, then the procedure is repeated.

Widely used in the non-surgical treatment of Dupuytren's contracture. enzyme preparation collagenase Clostridium histolyticum®, which, by injection into nodular formations, promotes the active breakdown of the protein structure.

American scientists have found that the rate of recurrence of the disease is about 60% after using the collagenase enzyme. The deterioration of the situation in such patients was recorded only after four years of observation.

Conservative treatment does not affect the reversibility of the processes, but only slows down the rate of development of Dupuytren's contracture.

Support drug therapy possible using alternative treatment folk remedies.

Help from traditional medicine

At the debut stage of the development of the disease, you can and should try to treat: with rubbing, heating, compression applications, baths and herbal infusions:

• aloe treatment. For cooking home medicine You will need the juice of a young plant, collecting which you can begin to lubricate the affected finger;
• for rubbing a sore finger, a product prepared on the basis is very effective. Per 100 g plant product, peeled, take 200 ml of vodka or diluted alcohol. The composition is infused for 3 days, then applied to the diseased surface;
• Red pepper, kerosene and sunflower oil will help give elasticity to the affected area. Medium-sized hot red pepper is crushed into small fractions and mixed with two parts kerosene and one part sunflower oil. Infuses healing mixture no more than 12 hours. Using a gauze pad, the medicine is rubbed into the patient light place massaging movements. This remedy can be used in the absence allergic reaction for medicinal ingredients;
• A compress made from boiled potatoes is beneficial for the joint. It is necessary to mash the potatoes boiled in their jackets, and after cooling to an acceptable temperature, apply them to the sore spot;
• Therapeutic baths made from pine buds are effective and harmless.

Despite the fact that the disease will continue to progress, hand exercises should be performed daily.

It is very effective to use a shoulder expander to not only pump up the shoulder muscles, but also, by firmly holding the handles of the gymnastic apparatus, to additionally warm up problematic arm joints.

A hand spring or rubber expander helps with Dupuytren's structure: you can not only strengthen your hands and improve blood supply, but also keep the ligaments and tendons of your fingers in good shape.

To slow down the progression of the disease, folk remedies, physiotherapy and gymnastic exercises won't be enough. It is necessary to reconsider your working conditions and the quality of food. To do this you need to reduce physical exercise on hand and exclude the consumption of certain foods, for example:

• table salt;
• refined sugar;
• cereal and legume products;
• smoked and fatty foods;
• fermented marinades.

It is necessary to monitor your water balance. Water consumption should not be lower than 2 liters per day, this also includes other liquids, soups, milk, juices.

To properly balance your diet, you need to consult a nutritionist.

Prevention

Upon receipt various kinds injuries (sprain, subluxation, bruise), the body in many cases is able to cope with the damage itself (provided that the injury was not severe). Due to pain, movements that prevent proper tissue healing are excluded. Over time, the impaired functions will return to normal, the pain will begin to subside. As a result, movements are disrupted for a short time and a persistent contracture does not have time to form. Contracture- this is a limitation of mobility in any joint due to illness or prolonged immobility (for example, after long stay hands in plaster). That is, the joint suddenly stops bending or bends with pain and difficulty. Multiple microtraumas can cause various contractures, including hand contracture. In turn, contracture of the hand (fingers) is chronic, developing disease connective tissue with a predominant lesion of the hand, this means that in the process of development, healthy tissues of the palm degenerate into fibrous tissue, as a result of which this contracture is formed. It is called - Dupuytren's disease and of all contractures it poses the greatest danger.
Usually, hand contracture usually occurs in men over 40 years of age who have been busy for many years manual labor(for example, drivers, tractor drivers, combine operators, turners, milling operators, mechanics). Due to constant injuries, permanent damage to the tendons of the hand occurs, the fingers freeze in a bent position and it becomes impossible to straighten them with voluntary movement.
The exact reasons for the formation of hand contracture have not yet been established. However, there are known risk factors, including: smoking, alcohol abuse, chronic microtrauma of the hand. The dependence of Dupuytren's contracture on diabetes mellitus was also established. A hereditary predisposition is also possible. In addition, in most cases, this disease manifests itself in those who previously suffered from arthritis and arthrosis, led sedentary lifestyle life and did not pay due attention to my health (which is why it happened that my hands gradually became weak and “ossified”). Also, stroke, heart failure, or a problem with blood supply are often sources of hand contracture.
Dupuytren's contracture often develops on both hands, but in most cases - on one, usually the right - in the area of ​​​​the little finger and ring finger. As a rule, this disease begins painlessly and imperceptibly - a nodule appears in the area of ​​​​the transverse folds of the palm, a subcutaneous compaction in the form of a pea, which is often mistaken for an ordinary callus. If the disease progresses, the nodule increases in size, then new nodules appear or cords of dense consistency appear, which capture more and more new areas of the palm, as a result of which a person cannot straighten one or two fingers (ring and little fingers). When the cord passes to the main phalanx (closest to the palm) of the finger, a flexion contracture of the metacarpophalangeal joint is formed (second stage), and compaction and shortening of the finger fibers lead to the formation of contracture of the middle phalanx of the finger - the third stage (at the third stage of the disease only a surgeon can help) . That is, over time, the cords begin to deform the hand and finger movements are limited.
Starting, as a rule, on one arm, the disease can then appear on the second. Or it may, as mentioned above, develop on both hands at the same time.
If measures are not taken in time, it will be difficult to straighten your fingers in the future. In severe cases of the disease, ankylosis is likely to develop - complete immobility of one or two fingers. That is why at the first signs of illness it is necessary to contact an orthopedist-traumatologist.
It must be said that due to the formation of contractures of the joints of the hands (even small ones), a person very often cannot take care of himself. Therefore, it is very important to promptly diagnose contracture of the fingers, which in the future will help to successfully fight the disease. In the event that they are discovered primary signs contractures of the hand, such as lumps on the palm, dysfunction of the fingers, it is necessary to urgently begin preventive measures.
The main tasks of conservative treatment of contracture of the hand (fingers) include:
- stretching the forearm muscles from the palm side
- increasing the strength of the forearm muscles on the opposite side
- activation of blood circulation in the problematic hand.
On early stages For diseases, physiotherapy is usually used, which includes: mud, paraffin treatments, medicinal electrophoresis, ultrasound. Also used special exercises with contracture of the hand, which are aimed at stretching the palmar fascia. During sleep, patients are recommended to use splint bandages (the plaster cast is not applied in a circle, but only on one side), fixing the fingers in the extension position. If the nodules are painful, a therapeutic novocaine blockade is done.
However, in most cases, sooner or later the question of radical surgical treatment arises. Moreover, the earlier the operation is performed, the less traumatic it is. And most importantly, hand function is restored better and faster in the future.
If the scars (strands) on the hand are small, then they are removed even under local anesthesia, and the duration of the postoperative period is only 8-10 days. If the disease is advanced, then the operation has to be carried out in several stages, while postoperative period usually takes many weeks. And in very severe cases when overgrown connective tissue compresses blood vessels or nerves, the finger may be amputated.
However the best method prevention and treatment of contractures is still the early prescription of physiologically based and correct movements. In this case physiotherapy with contracture of the hand it becomes simply irreplaceable. Due to muscle contraction and movement in the joints during exercise therapy for contracture of the fingers, a significant increase in tissue nutrition and metabolism occurs. Besides, therapeutic exercises for hand contracture prevents the onset of stiffness.
Treatment with movements for contractures of the hand is carried out in the form of passive and active therapeutic exercises. Passive exercises and massage for finger contractures help stretch contracted muscles and periarticular tissues. In the presence of Dupuytren's contracture, massage is usually done with stroking and rubbing movements, thus massaging the muscles of the forearm close to the hand. In the intervals between massages, passive development of the bent fingers of the affected hand is carried out using the healthy hand. The fingers are smoothly extended until tolerable pain appears. Therapeutic exercises for hand contracture should contain 5-6 massages and the same number of extension exercises and should last no more than 20 minutes.

Self-massage for hand contracture:
1) The forearm of the affected arm should be placed on the table, with the palm facing the body. It is necessary to relax the muscles on the palmar surface of the forearm, as a result of which the massage should be done with the maximum tolerable effort.
2) Grasp the forearm in the area of ​​the wrist joint with a healthy hand, with the thumb located on the side being massaged, and the other four fingers on the opposite side.
3) Then knead with pressing circular movements thumb the entire area from the hand to the elbow (in this case, four fingers located on the opposite side serve as a support and do not participate in the massage movement). Massage the palmar surface of the forearm with force for 5-7 minutes. 4) Next, you should move on to massage the opposite side of the forearm. The muscles of this area should be massaged with light stroking circular movements with four fingers from the hand to the elbow. This massage should take 1-2 minutes.
5) Then you need to move on to massaging your fingers. To do this, use the index finger and thumb of your healthy hand to press on the fingers of the diseased hand from the nail to the palm. You need to start with the thumb and end with the little finger. Pressure should be applied first from the front and back, and then from the sides of the fingers. Each finger must be massaged for 15-30 seconds.

Exercise therapy complex for hand contracture:
All therapeutic exercises for hand contracture (except 11-12) must be performed simultaneously with both hands.
1. I.P. – both hands lie on the table, palms down. Spread your fingers to the side (“spread”). Then return to the starting position. Moreover, the exercise should be performed more intensively with the sore hand. Repeat 10 times.
2. I.P. – hands lie on the table, palms up. Bend all your fingers into a fist, with your thumb on top. Repeat 10 times.
3. I.P. - the same. Alternately reach thumb to the tip of each finger (with force for the sore hand). Perform 10 times.
4. I.P. – arms bent at the elbows, hands in front of you. Perform an exercise called “shalbanchiki” - make a “shalban” with each of your fingers. Repeat 10 times.
5. I.P. – hands lie on the table, palms up. Perform the “pinch” exercise - squeeze all your fingers “into a pinch” (the exercise must be performed with five fingers). Repeat 10 times.
6. I.P. – both hands lie on the table, palms down. Perform the “claw” exercise - scratch your fingers on the table like a cat with its paw. Repeat 10 times.
7. I.P. – hands lie on the table, palms up. Bend your hand into a fist so that your thumb is inside the fist. Repeat 10 times.
8. I.P. – hands lie on the table, hands placed edgewise with palms facing each other, thumb raised up. Bend four fingers (except the thumb). Then move your thumb back. Perform 10 times.
9. I.P. – hands lie on the table, palms up. Bend your thumb. Return to starting position. Repeat 10 times.
10. I.P. – both hands lie on the table, palms down. Alternately bend and straighten all your fingers. Repeat 10 times.
11. Perform sequential active flexion and extension of the fingers in the first and second interphalangeal joints while fixing the affected finger with the healthy hand. 12. Perform passive flexion and extension of the fingers of the affected hand, while helping yourself with the healthy hand.

In addition, significant assistance in the treatment of hand contracture can be provided by special drug- Ronidaz is a grayish-yellow powder with a specific odor. Ronidase powder should be applied to a moistened sterile gauze pad (folded in 4-5 layers), and then the cloth should be applied to the affected area of ​​the hand and secured with a soft bandage. The bandage can be left on for 10-18 hours. When the dressing dries, re-moisten it and add the same amount of Ronidase. The procedure must be done daily for 15-60 days.
The most the best way Treatment of hand contracture is a combination of all the procedures described above - at night you need to make a compress with Ronidase, remove the compress in the morning. Then therapeutic exercises are performed for contracture of the hand, and self-massage is done in the evening.

Exercise therapy (physical therapy) for contracture of fingers:
Therapeutic exercises for contracture of the fingers consist of stretching the muscles of the palmar surface of the hand and strengthening the opposite muscles of the forearm.
1) I.P. - The hand lies on the table, palm up. With a healthy hand, you need to fix the base of the affected fingers, and then bend them (it is necessary that only the joints of the affected fingers participate in the movement). Repeat 8-10 times.
2) I.P. - the sore hand lies on the surface of the table, palm down, the hand lies on the scarf. Using your fingers, gather the scarf into a fist, then return to the starting position. Repeat 10 times.
3) I.P. - the hand lies on the surface of the table, palm down. Bend your fingers, clenching your hand into a fist, while your fingers should slide along the table. Return to starting position. Repeat 8-10 times.
4) I.P. - the sore hand lies on the surface of the table. Grasp any large object with your fingers spread as far apart as possible. Repeat 8-10 times.
5) I.P. - the hand lies on the table, palm down. Lift your fingers off the table, while trying to keep your hand in a stationary position. Repeat 10 times.
6) Roll a wooden block on the table surface with a sore hand.
7) I.P. - the hand lies on the table, palm down. Drum your fingers on the table.
Also, when therapeutic exercises are performed for contracture of the fingers, great benefit may benefit from the use of expanders. If you do about 10 sets of 10-20 compressions a day, you can provide strength to your arms and also return them to normal normal condition ligaments Besides, regular use The expander helps ensure that the vessels will never suffer due to Dupuytren's disease.

To prevent Dupuytren's disease (formation of contracture of the hand), gloves should be used when working (especially with metal), and made from the thickest fabric possible. And even under the mittens you need to use a softening and protective skin cream. It must be remembered that a long, tense, bent position of the hand significantly increases the risk of Dupuytren's contracture. Therefore, for every hour of such work, you need to perform gymnastics for at least 5-7 minutes - bending and unbending your hand.

In 1832, the French surgeon J. Dupuytren, while dissecting a hand with finger contractures, discovered pathological changes palmar aponeurosis, which he described as follows: “Having isolated the palmar fascia, I was amazed at how shortened, tense and retracted it was. From lower section fascia extends in cords to the affected fingers. I cut the growths that went from the fascia to the fingers, and the contracture immediately disappeared. I carefully examined the tendons - their surface was smooth, they retained their mobility, the joints were also healthy.”

After publication scientific works Dupuytren's disease is called Dupuytren's contracture, which, relative to other diseases of the musculoskeletal system, is diagnosed in 1.5-2% of patients, mainly men aged 40-60 years.

Cause of Dupuytren's contracture remains unclear. There are several theories about the appearance of contracture:

• traumatic,
• fibroblastic,
• endocrine,
• constitutional,
• hereditary
• neurogenic,
• others, less significant.

At the same time, none of them provides a comprehensive explanation of the pathogenesis of the disease.

Palmar aponeurosis (fascia) - a dense plate of connective tissue triangular shape, with its base directed to the head of the II-V metacarpal bones, and with its apex it passes into the narrow tendon of the palmaris longus muscle. In the absence of this muscle, the apex of the palmar aponeurosis merges with the holder of the flexor muscles and is covered on top by a thin layer of adipose tissue. The palmar aponeurosis consists of longitudinal and transverse bundles. Longitudinal bundles are concentrated over the tendons of the flexor muscles of the II-V fingers, forming pretendinous bands that pass to the palmar and lateral surfaces of the fingers, fuse with the skin and walls of the osteo-fibrous canal of the fingers. The transverse bundles form a wide layer of the aponeurosis, which has the appearance of a braid, and support the arches of the metacarpus.

The palmar aponeurosis, with the help of fibers, is closely connected with the skeleton of the hand, rich in sensory nerve endings, and is the place of origin of afferent impulses.
Tension and relaxation of the palmar aponeurosis under the influence of the long and short palmar muscles cause a slight suction effect and promote local blood and lymph flow.

Dupuytren's contracture can affect two or three fingers on one, or more often, both hands.

IN clinical course Dupuytren's contractures have four stages, the most common of which are the first three:

• Stage I is characterized by the appearance in the palmar aponeurosis of isolated seals not fused to the skin in the form of nodules or cords, painful on palpation. The function of the hand is not impaired, but hyperextension in the metacarpophalangeal joint of the affected finger is lost.
• Stage II is characterized by an increase and fusion of nodules, cords that adhere to the skin of the palm, in the folds of which a certain involvement is formed. The skin over the aponeurosis nodes becomes rough and loses mobility. In the metacarpophalangeal joints, the flexural contracture reaches 150°. Hand dysfunction occurs.
• On Stage III in the palmar aponeurosis, a dense scar conglomerate appears, fused to the skin along the entire length, with the presence of deep retracted skin. Fibrous nodes appear on the palmar surface of the main phalanges of the fingers. Diaper rash occurs in deep depressions of the skin. Flexural contracture in the metacarpophalangeal joints is estimated at 150-120°, and in the first interphalangeal joints - up to 150°. The functional ability of the hand is significantly impaired, cylindrical and layer-by-layer grip is lost.
• Stage IV is characterized by massive dense scar conglomerates not only on the palmar surface of the hand, but also on the main phalanges. The skin becomes motionless, with deep retractions. The fingers are bent at the metacarpophalangeal and proximal interphalangeal joints at an angle of 90° with hyperextension of the nail phalanges. The function of the hand is significantly impaired when the first finger is involved in the pathological process.

How to treat Dupuytren's contracture?

More often, patients seek medical help late, that is, in the event of significant contractures with impaired hand function. That's why conservative treatment is not always effective.

In the early stages, Plasmol injections are performed, vitreous, papain, applications of sage, ozokerite, paraffin, acupuncture, mud therapy is prescribed, which makes it possible to delay the progression of contractures, but a short time.
In some cases, injections of furazolidone solution are used to treat Dupuytren's contractures. The solution must infiltrate the entire scar conglomerate. The course of treatment consists of 3-5 injections with an interval of 12-14 days.

In the early stages (I-II), the aponeurosis nodules decrease and contractures do not progress. After infiltration of the fibrous conglomerate of the aponeurosis, compresses are prescribed with a 30-40% dimexide solution, after lubricating the skin with heparin and hydrocortisone ointments, sprinkle with furazolidone powder (2-3 tablets are ground).
Infiltration with furazolidone solution is also done on late stages diseases (as preparation for surgery). By infiltration with a solution of furazolidone, it is possible to soften the adhesions of the skin with the fibrous conglomerate and separate the skin from the scar-degenerated aponeurosis.

Surgical treatment is indicated in the later stages and consists of complete excision of the fibrous-degenerated palmar aponeurosis.

In case of old contractures of the fingers, to eliminate them, the wrinkled capsule of the metacarpophalangeal and first interphalangeal joints is additionally cut out along the volar surface.
In case of joint stiffness, in order to eliminate the contracture of the phalanx, it is necessary to perform arthroplastic resection of the interphalangeal joints.

What diseases can it be associated with?

In the metacarpophalangeal and first interphalangeal joints with Dupuytren's contracture, due to the constant forced bending position and limited movement, the joint capsule is affected by a significant scarring process. Joint rigidity is detected, which prevents the restoration of movement function after surgical treatment of contracture.

Dupuytren's contracture is always characterized by a progressive course. In some cases, the process occurs gradually, stretching out for 5 years or more. It happens when contracture proceeds malignantly - then all stages of the pathological process replace each other, reaching the fourth stage within a year.

Treatment of Dupuytren's contracture at home

Conservative treatment of Dupuytren's contracture does not require hospitalization. Most often used ambulatory treatment or the patient is recommended to visit medical institutions to perform specific procedures. The patient can carry out most of what is prescribed by the doctor independently at home.

If a patient is scheduled for surgery, the operation is most often performed under conditions day hospital surgeon of the relevant specialization.

What medications are used to treat Dupuytren's contracture?

basis drug therapy Dupuytren's contracture is considered to be. For infiltration with a solution of furazolidone, it is necessary to dissolve 0.02 grams of powder in 0.3 ml of heparin and 10.0 ml of 0.5% novocaine solution or 1% lidocaine solution.

Treatment of Dupuytren's contracture with traditional methods

The use of folk remedies, with the exception of sage lotions, does not demonstrate a pronounced effect. Applications from sage allow you to localize destructive processes in the joints, but should never be the only way to treat contractures, but only an addition to other physiotherapy and conservative treatment.

Treatment of Dupuytren's contracture during pregnancy

Dupuytren's contracture rarely develops in women, especially reproductive age. According to medical statistics, the disease is more common among mature and elderly men.

If the disease does occur in a pregnant woman, then the treatment strategy should not differ from the generally accepted one. The attending physician must be notified of the woman’s situation, conservative therapy will certainly be composed of those medicines that will not cause harm to any to the expectant mother, no fruit.

If possible, treatment can be postponed until after childbirth, since the disease does not always progress over years, or even a few months.

Which doctors should you contact if you have Dupuytren's contracture?

Clinical diagnosis Dupuytren's contracture is not difficult. On the palmar surface, often above the V or IV metacarpal bone, a dense subcutaneous nodule the size of a pea appears, painless on palpation, not mobile, not fused to the skin. Much less often such nodules are observed in region III, II or I metacarpal bones.

The nodule gradually enlarges or new ones appear, which eventually merge into one conglomerate; the skin over the fibrous nodules gradually loses its mobility and organically fuses with them. Later, similar fibrous compactions appear on the palmar surface of the main phalanges.

At first, the function of the fingers does not suffer from the appearance of nodules, only hyperextension in the metacarpophalangeal joints disappears. Subsequently, with an increase in the retraction of fibrous nodules, flexion contractures are formed in the metacarpophalangeal joints, and over time, in the first interphalangeal joints with impaired hand function. Significant depressions and diaper rash form in the folds of the skin.

Due to the fact that the fascial bundles of the palmar aponeurosis do not reach the nail phalanges, flexural contracture does not occur, and with flexion contracture of the main and middle phalanges up to 100-90°, the nail phalanges rest against the array of muscles of the eminence of the thumb and are pushed towards the dorsal surface, which leads to their hyperextension.

With Dupuytren's contracture histological studies in the palmar aponeurosis show pronounced dysplastic changes with the proliferation of fibroblasts, the formation of collagen fibers, and the formation of a dense scar cord instead of an elastic sheet.

Treatment of other diseases starting with the letter - k

Palmar fascial fibromatosis Dupuytren's is a non-inflammatory disease that causes scarring of the palmar tendons. This disease affects people in Scandinavia, Ireland and of Eastern Europe. Dupuytren's contracture is characterized by the fact that the patient's one or two fingers stop straightening, a kind of lump forms in the area of ​​the affected tendons, and the hand partially loses its functions.

What is Dupuytren's contracture?

A disease that results in hand deformity is Dupuytren's contracture. The disease affects the ring and little fingers. Dupuytren's syndrome develops with excessive development of connective tissue, leading to contraction of the fascia in the palm. The ICD-10 code is M72.0. The disease is not associated with disorders of carbohydrate, protein or salt metabolism. As a result of the pathological process, the patient loses the ability to straighten one or two fingers; in advanced cases, stiffness of the fingers develops. The disease can degenerate into damage to the aponeurosis of the feet.

Causes

On this moment The exact causes of finger contracture have not been established. The occurrence of the disease is influenced by heredity and age (it occurs very rarely in young people). In men, contracture occurs more often and develops more rapidly than in women. Smoking and alcohol abuse increase the likelihood of Morbus Dupuytren disease. Another factor that increases the risk of disease is diabetes.

Symptoms

Doctors identify the following signs of the disease:

1. Impaired ability to straighten fingers.
2. Stiffness of the joints of the involved fingers.
3. Development of ankylosis.
4. Deformation of the hand, the appearance of a seal in the palm.
5. Formation of subcutaneous hardenings that thicken over time.

Degrees

Contracture of the fingers develops without certain patterns. In some cases, Dupuytren's disease remains in the initial stages for many years, in others, within a few months the disease reaches the final stage. Depending on the severity of symptoms, there are three degrees of palmar aponeurosis:

1. First. The diameter of the nodular growth on the palm does not exceed 1 cm. The cord may appear on the palm or in the area of ​​the metacarpophalangeal joint. It is possible to treat Dupuytren's contracture without surgery.
2. Second. The cord is located in the area of ​​the main phalanx and becomes denser and rougher. The skin on the palm becomes rough, funnel-shaped depressions and retracted folds form at the site of the lesion. The affected fingers are bent at the metacarpophalangeal joint at an angle of 100 degrees and completely lose the ability to straighten.
3. Third. The strand forms on the middle or nail phalanges. Flexion and extension movements are limited. The phalanges are located at an angle of 90 degrees to each other, ankylosis is possible.

Diagnosis of Dupuytren's contracture

Making a diagnosis begins with interviewing the patient: the doctor needs to know about the patient’s complaints, the effect of contracture on the quality of life, and the duration of the disease. The doctor may ask whether the patient is abusing alcoholic drinks and smoking, about cases of contracture in the patient’s relatives. The next stage of diagnosis is a physical examination. The doctor examines and palpates the hand, studies the amplitude of flexion and extension of the fingers. Laboratory and instrumental methods are not used to diagnose the disease.

Treatment of Dupuytren's contracture

The treatment of the disease is carried out by branches of medicine: orthopedics, surgery, traumatology. They use operational and conservative methods therapy. At pain syndrome therapeutic blockades are used with hormonal drugs(Diprospan, Triamcinolone, Hydrocortisone). Treatment of neurogenic contracture without surgery is possible only in the initial stages. If you don't see a doctor in a timely manner, your finger may need to be amputated.

Operational

Treatment of contracture of the fingers occurs using methods surgical intervention:

1. ​Aponeurectomy. Indicated when the finger is bent 30 degrees or more. In a partial aponeurectomy, only the aponeurosis with scarred tissue is removed. The operation takes long time, but the palmar aponeurosis, unchanged by scars, is not always completely removed.
2. Aponeurotomy:

• ​Needle fasciotomy. The doctor uses a needle to cut scar changes on the palm and fingers. The ability to straighten the fingers is gradually fully restored. This method has virtually no contraindications, guarantees low trauma, and, when following all instructions, ensures quick rehabilitation, resumption of extension function immediately after surgery.
• Open fasciotomy. Carry out on late stages diseases under local anesthesia. The doctor makes an incision at the site of scarring and cuts damaged tissue. After reconstructive surgery, the aponeurosis may heal again, which will lead to a repeated visit to the doctor. The risks of the operation are much higher compared to needle fasciotomy, and reviews are conflicting.

Collalysine

How to treat Dupuytren's contracture if surgery is contraindicated? In such cases, it is recommended to use collalysin injections. The patient is injected with Xiaflex into the healed fascia. The medication provokes its disintegration and the disappearance of the scar. The procedure is performed on an outpatient basis and takes about half an hour. After completion, the patient is given a bandage or splint. The scar resolves the next day, leaving no marks on the skin. After the injection, the ability to straighten the fingers is completely restored.

Folk remedies

Treatment with folk remedies can be used as an addition to traditional methods. Used for home treatment traditional methods:

1. Baths. Thermal procedures improve blood circulation. Hands are steamed in a salt infusion of chamomile, sage, and vegetable peels.
2. Compresses. For the compress, use black poplar buds, Echinops seeds, horseradish root, and vodka.
3. Rubbing. Brushes are rubbed with tinctures from vegetable oils with the addition of red pepper, rubbing from chestnut infusion gives a good effect.

Physiotherapy

The goal of therapeutic exercises is to improve the elasticity of the aponeurosis and increase the motor activity of the finger joints. Every two hours you need to straighten and bend your fingers about 20 times. Before and at the end of the exercise, massage the hands, and for better effect it is recommended to use a rubber expander. Every day you need to increase the number of repetitions, pain in muscles and ligaments is allowed.

Video: palmar fibromatosis