Dupuytrens Contracture is a common condition. It classically presents itself as a contracture of the finger, usually in the ring and/or little finger. It affects more men than women and generally occurs when people are in their 50s or 60s.

What is the cause ?

The exact cause is not known but it is related to your genes and can sometimes be seen in your family history.

What are the symptoms?

The first evidence of the condition is usually in the appearance of a nodule in the palm of the hand near to the base of the affected finger(s). This may progress to become a fibrous band running from the finger to the palm. This gradually draws the finger down into a bent position until it is no longer possible to keep the finger straight.
It is important to be aware that.

• Dupuytrens Contracture is not malignant
• It does not involve the tendons
• It is rarely painful
• The problem can return even after surgery but continued therapy will help to alleviate the symptoms.
• If you are prone to developing dupuytrens condition then any injury may accelerate the onset.
• Surgery can help to restore hand function but it will not cure the condition

What is the treatment?

Surgery involves a zigzag incision being made in the palm and/or finger(s) so that the affected tissue can be removed. If your finger has been contracted for a long period then it may not be possible for your surgeon to restore your finger to a fully straight position.

After surgery you will be fitted with a moulded night splint. You will be required to wear this each night for at least 24 months. Your physiotherapist will advise you if your splint becomes uncomfortable and they will also give you guidance on washing and careful for your splint.

Aftercare

Following surgery it is essential that you attend regular outpatient hand therapy treatment. This will involve physiotherapy that will help to improve/restore maximum hand function. Your physiotherapist will give you a few simple exercises to do and will teach you how to massage your scar.

It is important that you keep your hand elevated following surgery to help prevent any complications due to excess swelling.

Your wound will be monitored after surgery and your dressings will be changed between physiotherapy sessions to encourage your wound to heal and to prevent any infections.

It is important that you bring your splint with you to each appointment after surgery. This is because it may be necessary to alter your splint as your hand gets better.

Good nutrition helps wounds to heal so it is important that you eat a balanced diet. Whilst your hand is out of action it may be advisable to seek some help to prepare meals.

Smoking slows down healing. This is because smoking causes the blood vessels to constrict and reduces blood flow and oxygen. These are both essential to aid the healing process. It is important that you stop or cut down smoking for 3 weeks before and after surgery.

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Carpal Tunnel Syndrome refers to the space formed in the wrist by the bones and ligaments through which the tendons to the fingers pass. This space contains the median nerve that controls the movement of the thumb and the feeling that occurs in your thumb, index and middle fingers.

What is the cause?

There is no one cause but it may be due to a build up of retention of fluid. It can also occur after a fracture in the wrist where the position of the bone has been altered.
It may also be associated with diabetes or an underactive thyroid. It is most common in women and can affect all ages.

What are the symptoms?

Carpal Tunnel Syndrome is evident by pain, tingling, numbness of the thumb, index and middle fingers and can be worse at night. This can affect your sleeping. Occasionally the whole of the hand and forearm may be affected.

If present for a long period of time the muscles around the thumb can waste away causing your grip to become weakened.

What is the treatment?

Mild symptoms may go away by themselves, for example, after pregnancy or after a flare up of arthritis.

In some cases your doctor may give you a splint to wear and you may be referred to a physiotherapist. Steroid injections may also be given into the carpal tunnel to relieve symptoms.

In more severe cases surgery may be carried out under local anaesthetic to release pressure on the nerve. This procedure usually resolves symptoms quickly and only leaves a small scar.

Aftercare

As with any surgical procedure you will be advised by your surgeon how best to support rapid healing and rehabilitation.

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Occasionally referred to as Washerwoman’s sprain or tenosynovitis, De Quervains Syndrome is an inflammatory disorder affecting 2 tendons that are enclosed in a small compartment which move the thumb outwards from the palm.

What is the cause?

De Quervains Syndrome occurs when the tendons become irritated.

What are the symptoms?

A swelling and tenderness over the tendons that causes an ache down in to the thumb and up/in the forearm.
Pain occurs when movements of the thumb and/or wrist move in the direction away from the palm.
Movement of the thumb and wrist may also be limited and a crackling of the tendon might occur.

What are the treatments?

Treatment may vary dependent on the severity and duration of the condition. Mild symptoms may disappear by themselves.
In some cases your doctor may give you a splint to wear and you may be referred to a Physiotherapist.
Steroid injections may also be given to relieve symptoms.
In more severe cases surgery may be carried out to release the tendons.

Aftercare

As with any surgical procedure you will be advised by your surgeon how best to support rapid healing and rehabilitation.

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