Dupuytren's contracture: treatment

Dupuytren's Contraction

Dupuytren's Contraction(palmar fibromatosis) is a noninflammatory disease in the process of which the scar degeneration of the palmar tendons occurs.

Because of the proliferation of the connective tissue, the tendons are shortened, the extension of one or more fingers is limited, the flexion contracture develops with a partial loss of the function of the brush. It is accompanied by the appearance of a dense knotted strand in the area of ​​the affected tendons.

In mild cases, there is a slight restriction of extension, with progression, stiffness or even ankylosis (complete immobility) of the injured finger or fingers can develop. The causes of the disease are still unknown.

In the early stages, conservative treatment is possible, but in most cases Dupuytren's contracture progresses, and surgical intervention remains the most effective way to treat it.

It leads to restriction of extension and formation of flexural contracture of one or more fingers.

In the early stages of the disease, conservative techniques are used, but the most effective treatment is surgery.

Dupuytren's contracture is quite common in orthopedics and traumatology, which is more common in middle-aged men. Half of the cases are bilateral.

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Approximately 40% of cases affect the ring finger, 35% - little finger, 16% - middle finger, 2-3% - the first and second finger. In women, it is detected 6-10 times less frequently and proceeds more favorably.

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At occurrence at a young age, a more rapid progression is characteristic.

Causes of development

Dupuytren's contracture is not associated with impaired protein, carbohydrate, or salt metabolism. Some authors argue that there is a definite relationship between the onset of the disease and diabetes, but this theory has not yet been proved.

There are also traumatic (due to trauma), constitutional (hereditary features of the structure palmar aponeurosis) and neurogenic (defeat of peripheral nerves) theory, but the opinions of scientists remain contradictory. In favor of the constitutional theory testifies to a hereditary predisposition. In 25-30% of cases, patients have close blood relatives suffering from the same disease.

Dupuytren's contracture has a very characteristic clinical picture, which is difficult to confuse with the symptoms of other diseases. On the palm of the patient, a seal is formed, formed by a node and one or several subcutaneous strands. Extension of the finger is limited.

Appear strands, departing from it to the main, and then - and to the middle phalanx of the affected finger.

Because of the shortening of the tendon, first a contracture is formed in the metacarpophalangeal, and then - in the proximal (located closer to the center of the body) interphalangeal joint.

The skin around the knot becomes denser and gradually soldered to the underlying tissues. Because of this, convexity and retraction appear in the lesion. When you try to unbend your finger, the knot and strings become sharper, clearly visible.

Usually Dupuytren's contracture is formed without pain and only about 10% of patients complain of a more or less severe pain syndrome.

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Pain, as a rule, is given in the forearm or even the shoulder. Dupuytren's contracture is characterized by a progressive course.

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The rate of progression of the disease can fluctuate and does not depend on any external circumstances.

Degrees

Given the severity of the symptoms, three degrees of Dupuytren's contracture are distinguished:

The first. A dense knot with a diameter of -1 cm is found on the palm of the hand. There is a cord located on the palm of your hand or reaching the area of ​​the metacarpophalangeal joint. Sometimes pain is manifested when palpation.

The second. The weight becomes more coarse and hard, spreads to the main phalanx. The skin also coarsens and cools with the palmar aponeurosis.

In the lesion area, there are visible funnel-shaped depressions and retracted folds.

The affected finger (or fingers) are bent in the metacarpophalangeal joint at an angle of 100 degrees, extension is impossible.

The third. The weight extends to the middle, less often - to the nail phalanx. In the metacarpophalangeal joint, a flexural contracture with an angle of 90 or less degrees is detected.

Extension in the interphalangeal joint is limited, the degree of restriction may vary. In severe cases, the phalanges are located at an acute angle to each other.

A subluxation or even ankylosis is possible.

Sometimes a slight restriction persists for several years or even decades, and sometimes only a few months from the onset of the first symptoms to the development of stiffness. A variant with a long stable course is also possible, which is followed by rapid progression.

Diagnostics

Diagnosis Dupuytren's contracture is exposed on the basis of patient complaints and a characteristic clinical picture. During the examination, the doctor palpates the patient's palm, revealing the knots and cords, and also estimates the amplitude of movements in the joint.

Additional laboratory and instrumental studies to confirm the diagnosis are usually not required.

The treatment of Dupuytren's contracture is dealt with by traumatologists and orthopedists. Treatment can be both conservative and operative. The choice of methods is made taking into account the severity of pathological changes.

Conservative therapy is used in the initial stages of Dupuytren's contraction.

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The patient is assigned physiotherapy (thermal procedures) and special exercises for stretching the palmar aponeurosis.

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You can also use removable longes, fixing the fingers in the unbending position. As a rule, they wear them at night, and in the daytime they take them off.

In case of persistent pain syndrome, therapeutic blockades with hormonal preparations (diprospan, triamcinolone, hydrocortisone, etc.) are used.

The drug solution is mixed with a local anesthetic and injected into the area of ​​the painful node. Usually the effect of one blockade persists for 6-8 weeks.

It should be borne in mind that the use of hormones is one of the methods of treatment that should be used with caution. Conservative agents can not eliminate all manifestations of the disease.

Clear recommendations on the severity of the symptoms, in which it is necessary to conduct surgical treatment, are currently not available.

The decision to make a surgical intervention is based on the rate of progression of the disease and the patient's complaints pain, limitation of movement and associated difficulties in self-service or the performance of professional responsibilities.

Typically, doctors recommend surgery if there is a flexural contracture with an angle of 30 or more degrees.

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The purpose of the operation, as a rule, is to excise scar tissue and restore the full volume of movements in the joints.

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However, in severe cases, especially - with chronic contractures, the patient may be offered arthrodesis (creating a fixed joint with a fixation of the finger in a functionally advantageous position) or even amputation finger.

Reconstructive surgery for Dupuytren's contracture can be performed under general anesthesia or local anesthesia.

With pronounced changes from the skin and palmar aponeurosis, surgical intervention is quite long, therefore in such cases general anesthesia is recommended.

The choice of a particular method is made taking into account the peculiarities of the location of scar tissue. During the operation, the palmar aponeurosis is completely or partially excised.

In the presence of extensive adhesions, which are usually accompanied by thinning of the skin, you may need dermoplasty with a free skin flap.

Then the wound is sutured and drained by a rubber graduate. A hard pressure bandage is applied to the palm, which prevents blood accumulation and development of new cicatricial changes.

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The hand is fixed with a gypsum longus so that the fingers are in a functionally advantageous position. Sutures are usually removed on the tenth day.

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In the future, the patient is prescribed therapeutic gymnastics to restore the volume of movements in the fingers.

Sometimes (especially in the case of early onset and rapid progression), a relapse of contracture can occur over several years or decades. In this case, a second operation is required.

A source: http://www.krasotaimedicina.ru/diseases/traumatology/dupuytren-contracture

Dupuytren's contracture: treatment without surgery, physiotherapy

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

According to statistics, this pathology affects about 3% of the population of our planet. Mature men are more often ill - from 40 to 60 years. Only in 4-8% of cases it is diagnosed in women.

Dupuytren's contracture is not a fatal disease, but it leads to persistent impairment of the function of the hand, which is unacceptable for able-bodied men.

That is why it is important for every person to have an idea of ​​what is palmar fibroids, why he arises and how it manifests itself, as well as the methods of diagnosis and treatment of this condition - both without surgery, and surgical. It is these moments that will be considered in our article.

Causes and mechanism of development

Although Dupuytren's disease was discovered quite a long time ago, and in the medical literature there are already many publications on this subject, to say with certainty why this pathology arises, scientists are still not can. It is proved that heredity is of great importance - in a genotype of members of one family suffering from palmar fibroblasts, a gene was found that is absent in healthy individuals. But not all carriers of this gene get sick. It is likely that the disease has manifested itself, it is necessary to influence the organism of a person predisposed to it by one or several risk factors. These are:

• injuries of the hands (as a single severe injury, and multiple minor injuries);
• bad habits (smoking, alcohol abuse);
• working conditions (a profession that involves hard work with hands);
• age, sex (men over 40 years of age);
• some diseases of other organs and systems (diabetes mellitus, epilepsy, liver disease and others).

So, a person who has a gene in the genotype responsible for the development of Dupuytren's contracture is exposed to one or more of the factors listed above.

In the area of ​​tendons of his palms (palmar aponeurosis) a number of processes are activated, resulting in replacement of the physiological tissue of the tendon of the pathological cicatricial.

This leads to the appearance of clinical signs of the disease.

Symptoms, periods and stages of the disease course

In such patients, the function of the brush is impaired due to the impossibility of unbending one or more fingers.

Dupuytren's contracture is a disease with a chronic, steadily progressing course.

If it develops in adulthood, it usually progresses slowly, and in young people it proceeds more aggressively, develops rapidly.

In most cases, only the individual rays of the palmar aponeurosis (usually the IV or V finger) of one hand are affected at the initial stage of the disease.

Over time, the pathological process spreads, and in the final of the disease, a 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 appearance of typical symptoms of this pathology, many patients experience morning stiffness, a feeling of fatigue, heaviness, aching pain in the hands, numbness of the fingers. Sometimes there is dryness, a slight compaction of the skin of the palms, a flattening of the folds on it. This period lasts for 8 years.
2. The period of initial manifestations. Man notes the appearance of the first symptoms of the disease - atrophic changes of subcutaneous fat, nodes located under the skin, as well as depressions on it. It lasts up to two years.
3. The period of progression. The lesion area gradually increases - under the skin are determined not only nodules, but also rough connective tissue strands along one or more fingers, especially well visible when trying the patient Unbend a finger. A flexural contracture is formed, that is, the patient can not completely unbend the affected finger due to the fact that the tendon replaced with scar tissue is shortened and becomes inelastic. Also on the palm appear well visible on the eye grooves in the area of ​​the folds of the skin, the pulling of its funnel-like shape, the areas of peeling, inflammation, atrophy. In some cases even bedsores develop. Skin rough, dense.
4. Late period. In the pathological process, the palmar aponeurosis is fully involved. Flexural contractures of several joints developed (the so-called fibrous ankylosis), and dislocations and subluxations appeared in neighboring joints. Skin thick, rough, dry, subcutaneous fatty tissue is atrophied. Further, there is simply no other way to progress, so it no longer develops. But the patient does not get any better from this, because the functions of the brush are seriously violated, and in order to partially correct them, a series of surgical interventions is needed.

The pain for this pathology is almost not typical - painful sensations in the lesion zone are noted by only 10% of patients.

Depending on the severity of the contracture of the finger, four degrees of the disease are distinguished:

I - in the region IV or V of the ray of the palmar aponeurosis (i.e. the tendons of the corresponding fingers), the compaction located under the skin is determined; it absolutely does not interfere with a person in the home, since it does not affect the extension of the finger; of course, at this stage only a few patients.

II - the disease progresses; Extension of the finger is limited to 30 °; patients note some visual defect of the hand and a slight restriction of its functions, but at this stage, only a small part of them consult the doctor, most of them hope that "nothing terrible" and "everything will pass away" itself ".

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III - it is impossible to unbend the affected finger, it is at an angle of 30-90 ° to the brush, the function of which is sharply limited; here already patients go to the doctor for help, but nothing more than a series of operations to restore the functions of the brush, he does not offer them can.

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

Principles of diagnostics

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

Any laboratory or instrumental diagnostic methods, as a rule, are not required for the diagnosis. In some cases, for the purpose of differential diagnosis, a radiograph of the hands may be recommended to the patient.

Tactics of treatment

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

Conservative treatment

Methods of conservative therapy do not lead to recovery of the patient, but only slow the progression of his illness.

They are most effective at the first stage of the pathological process, but can also be prescribed to the patient with his categorical refusal of the operation, and also at the stage of rehabilitation after it.

Carry out treatment without surgery in a polyclinic course twice a year. Its components are:

• taking medications;
• physiotherapy.

From medicines to the patient, as a rule, appoint:

• injections of glucocorticoids - dexamethasone, diprospan and others (depress inflammatory process and reduce pain);
• applications on the affected zone of proteolytic enzymes - lidase, trypsin, ronidase and other (activate the metabolic processes in the affected tissues, soften the scar tissue, slow down degeneration);
• xiaaflex is a specific combination preparation, the ingredients of which have a destructive effect on collagen; It is specially designed for the treatment of Dupuytren's contracture; injected into the area contracture.

Physiotherapy

To stimulate the work of the muscles of the hand and reduce the tension of the tissues under Dupuytren's contracture, electrotherapy can be prescribed.

Methods of physiotherapy are an important component of the complex conservative treatment of Dupuytren's contracture, and are also used in the rehabilitation stage after surgery.

The doctor, appointing the patient one or more methods of therapy by physical factors, 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 its softening;
• restoration of the volume of movements in the joint involved in the pathological process.

Reduce the tension of scar tissue will help:

• low-frequency electrotherapy;
• laser therapy infrared;
• local darsonvalization (contributes to better nutrition of tissues in the area of ​​exposure, apply a labile technique with a current strength of not more than 10 μA; duration of the session is 10 minutes, the course of treatment includes 8-10 exposures).

Improve the condition of the rumen following methods:

• ozokerite applications;
• paraffin therapy;
• healing mud.

Slow process of scar formation, activate resorption of scar changes such methods:

• compresses with dimexid and proteolytic enzymes - lidase, trypsin, ronidase and others (drugs destroy peptide bonds of scarring collagen, not acting at the same time on the collagen physiological; powder ronidasy poured on pre-moistened boiled water gauze cloth, then superimposed it on the affected area, covered with special paper, cotton wool and fixed in this position for 12-18 hours; make such a compress every day up to 30 impacts; if lidaz is used, the 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);
• drug electrophoresis and phonophoresis of the same.

To expand the vessels in the area of ​​damage, thereby improving the flow of blood to it, the patient is assigned:

In order to stimulate the work of the muscles of the brush, apply:

• interference therapy;
• electromyostimulation.

Surgery

Flexural contracture of the finger with an angle of more than 30 ° (i.e., stage III of the disease) is a direct indication for surgical intervention.

Many experts believe that it is necessary even earlier - in the II stage, if the patient has already consulted a doctor.

However, with regard to the latter situation, an individual approach with an features of the course of the disease (the rate of its progression, the presence of predisposing factors, the age patient).

After suturing the wound, the surgeon puts a dense sterile bandage on the palm and fixes the finger in the physiological position for him with a functional tire.

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.

The essence of it is to create a joint that is incapable of movement, with the fixation of the finger itself in a 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 convenient for the patient and is not a cosmetic defect.

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In a number of cases, as a rule, at the IV stage of palmar fibromatosis, the doctor recommends the patient amputation (removal) of the affected finger.

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

Despite the fact that surgical treatment allows the patient to increase the functional capacity of the brush and improve the quality of his life, in almost half the cases described by us pathology after surgery occur relapses. Especially high risk for young patients with rapid development of the disease. Such situations require repeated intervention by the surgeon.

Previously, the operations performed under Dupuytren's contracture were accompanied by a high risk of developing all sorts of complications.

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, because sooner or later it leads to permanent deformations of the brush.

In the early stages of the disease the doctor recommends the patient treatment without surgery, including medications, therapeutic massage and physiotherapy techniques.

Such therapy will not lead to recovery, but it can significantly slow the progression of the disease, while maintaining the efficiency of the brush.

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In advanced cases of the pathological process without surgical intervention is indispensable, however, it does not guarantee the restoration of the volume of movements in the affected joints.

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From what has been written above it follows that it is important for every person to be attentive to the state of their health and, when their condition worsens, they should consult a doctor.

In this case, the probability of a positive result of treatment is maximal.

Yes, and let others think that you are a reinsurer, than later you will reproach yourself for not being able to get back time to get medical help in a timely manner.

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

A source: http://physiatrics.ru/10004854-kontraktura-dyupyuitrena-lechenie-bez-operacii-fizioterapiya/

Dupuytren's contracture - treatment without surgery, rehabilitation after surgery

Currently, joint diseases are in the group of the most common diseases.

Unfortunately, quite often you can find such a disease as Dupuytren's contracture, when flexion of the joint brings severe pain or is completely unattainable.

Outwardly, the ailment can be manifested by hardness and the formation of nodules. Such signs contribute to scarring and subsequently lead to the lack of the possibility of flexion of the fingers.

This disease, Dupuytren's contracture, is popularly called "French disease". It manifests itself in the form of compaction on the hand and develops over a long time.

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

Description of the disease

Dupuytren's contracture (palmar fibromatosis) is a disease in which the tissue on the palms that covers the fingers and tendons can thicken and become covered with numerous scars. His code for ICD-10 (International Classification of Diseases): M72.0.

The injured tissue, which specialists call the palmar fascia, becomes more rigid, and eventually wrinkles. As a result, the fingers curl inward towards the palm.

Palmar fibromatosis is able to affect absolutely any fingers of the hand, but more often it affects the little finger or an unnamed one. In very rare cases, the ailment affects the forefingers and thumbs.

In addition, palmar fibromatosis is able to hurt one hand, and both.

Dupuytren's contracture: what to do when the knots and fingers do not straighten out on the palm of your hand?

Causes of Dupuytren's contracture

Despite the fact that Dupuytren's contracture has recently become an increasingly common condition, its causes are not yet fully understood.

Interesting is the fact that men most often suffer from this disease, in most cases of mature age.The elderly men of the age of 60 are most likely to fall ill.

By the way, palmar fibromatosis is often inherited.

The most common causes of Dupuytren's contracture include:

• epilepsy;
• diabetes mellitus (first, second type);
• problems in the thyroid gland;
• Smoking is one of the most probable causes of the disease;
• work in production;
• alcohol abuse (especially if the liver is severely damaged);
• the use of anti-epileptic drugs can also trigger the development of the disease.

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

When the disease progresses, dense and fairly thick nodes form under the skin. The thicker these knots become and increase, the more fingers will stop flexing, characteristically remaining bent inside the palm of your hand.

Stages of the disease

1. Proliferative phaseIs the phase during which the nodule begins to develop. At the beginning of the disease, patients feel discomfort, less often pain.

   Painful manifestations are the result of the fact that the nerve endings have penetrated into the fibrous tissues or simply because of the infringement of the nerves. During visual inspection, the paleness of the skin on the arms is clearly visible.

2. Involutionary phase- the disease begins to spread into the tissues and thickened longitudinal nodes are formed.
3. Residual phase- the disease continues to progress and enter into the tissues, the node or nodes become denser, contractions begin to form.

How to treat Dupuytren's contracture?

It is sad, but in most cases, patients turn to doctors for help too late, even if significant contractures develop, as well as with a violation of the hand.

Therefore, treatment of Dupuytren's contracture without surgery can be effective only at the initial stages of the disease. These methods include physiotherapy, lfk, massage and other special exercises with Dupuytren's contracture.

But in most cases, doctors prescribe therapy with medication. For example, local inflammation should be injected with some corticosteroid drugs.

Also in the early stages, doctors prescribe paraffin treatment, vitreous injection, plasmin, papain, ozocerite, sage, acupuncture, mud therapy, which makes it possible to stop the progression of contractures, albeit on a short time.

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

In addition to these methods, many resort to treatment with ointments and gels based on homeopathy. Others like the effect of the use of the medical preparation of Konraktubeks.

Suffice it to prove effective treatment Vitafon - painless procedure shock wave therapy.

During this time, the device generates a wave, which is directed directly to the focus of the disease.

Such an effect can cause positive changes in the connective tissue.

Sometimes experts recommend the formation of a fixed joint in order to immobilize the fingers. In exceptional cases, if the connective tissue has grown and it leads to infringement of the blood vessels and nerves, it is advisable to perform an amputation of the finger.

What to do if the fingers do not straighten out

Treatment of Dupuytren's contracture with folk remedies

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

Mixture of chestnuts for grinding. For its preparation you need from 200 to 400 grams of chestnuts and half a liter of vodka. First, clean the chestnuts from the solid peel, grind them well with a normal fork or with a mortar, pour the pieces of chestnuts 500 ml of 40% vodka.

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

In order to avoid allergies, first apply a 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 and inflammation.

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Infusion of kerosene. To prepare medicinal tincture, you need to prepare one glass of kerosene, a glass of sunflower oil and about five fruits of red hot pepper.

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

After this, apply gauze dressings to painful places, or woolen ones, if you do not have allergy to wool.

Important: if pepper causes you allergic reactions, this infusion will not work for you, because there is a risk of urticaria.

Treatment of aloe contracture. To prepare this medicine, you must prepare one mature, dense leaf of aloe.

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

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

Treatment with an expander of contracture. The expander is a small sports device designed specifically for the hands. Doctors recommend using it on a regular basis, 8 to 10 sets of at least 10-20 compressions per day should be made.

Healing pots of potatoes. To prepare such a remedy, you will need to clean potatoes (approximately 5-7 potatoes), 1 beet, 1 carrot, 1 onion.

In a large pot, pour about 4-5 liters of water, add potato purification and other vegetables, 1 tablespoon of salt and 20 drops of iodine to it. Cook on low heat, this means you need about 40 minutes.

At the end of this time, remove the pan from the fire and set it to cool. Then, when the temperature of the broth is about 30-40 degrees, lower the affected limbs in a pan with broth for 7-15 minutes. Try to unclench and compress the brushes in the water.

Massage with Dupuytren's contracture. Massage with olive or butter has proved to be one of the most effective methods for this disease.

It is most useful to use natural home-made oil, but if you do not have one, you can use the purchased one. With light circular movements, first massage the fingers about 5 minutes, then the palm.

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Important: do not press very hard on the palm, as this can cause severe pain.

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A useful recommendation: during the period of illness, patients often complain about extreme dryness of the hands, so the solution to the problem is a usual children's or moisturizing cream.

However, it will be of use only if it is used constantly - from 5 to 7 times a day, especially do not forget to lubricate the palms with cream for the night.

Means from contracture for oral administration

For its preparation, chestnut flowers insist on vodka, in the ratio: one small handful of flowers per half a liter of vodka, for two weeks in a dark cool place. At the end of this time, the infusion should be carefully filtered and take 30 drops 3-4 times a day.

According to numerous testimonies of patients, an excellent effect is provided by tincture of oats, but only with prolonged use (at least a year).

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

At the end of this time, it is necessary to boil the solution, again allow it to settle, add water to one liter and take 3 times a day for 100 ml for 45 days. Then follows the month of the break, and after it the course of treatment is recommended to be repeated.

Features of nutrition in the period of illness

It is recommended to add more tomatoes to the diet, since they act as antioxidants (rich in lycopene). Its effect favorably affects the nodes, softening and reducing them in size.

As an option, you can try the "Stone Age diet" or in another way it is called "Palaeolithic."Here's what it includes:

• Nuts and seeds;
• eggs;
• olive and coconut oils;
• fresh vegetables and fruits;
• meat;
• Water is not less, liter per day.

Products to be excluded:

• refined sugar;
• dairy;
• potatoes;
• Refined vegetable oils, such as rape;
• salt;
• cereals;
• beans.

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

Such a diet should be under the careful supervision of specialists, so be sure to consult your doctor.

Rehabilitation after Dupuytren's contracture surgery

After surgery, raise your hand to avoid swelling, and apply a special ointment to the seam for faster healing.

A few weeks later, doctors appoint warm baths, regular lubrication of hands with fat cream and massages.

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

However, in the treatment of contracture folk recipes will require maximum care and the ability to allocate time for procedures.

After the operation, they are most often prescribed:

• baths;
• rubbing;
• compresses.

Specialists who work with patients with Dupuytren's contracture every day, notice that the frequency of relapses is very high.Even after a full course of treatment, the symptoms of an illness can return.

Therefore it is very important to apply all the advice and instructions of the attending physician, take care of your diet and often be in motion.

The good news is that Dupuytren's contracture is virtually painless, and the vast majority of patients who seek help on time will soon recover.

These materials will be of interest to you:

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A source: http://lechenie-narodom.ru/kontraktura-dyupyuitrena-lechenie-v-domashnih-usloviyah/

Dupuytren's Contraction

Palmar fibromatosis (Dupuytren's contracture)- This is a violation of the function of the flexor flexors of the hand as a result of pathological processes in the palmar aponeurosis.

There is a fusion of the skin and flexor tendon with the formation of scar tissue, resulting in there are restrictions in the movement of the phalanges of the fingers (contracture), and in severe cases - complete lack of movement (ankylosis).

The disease affects the elderly, mostly male.

If palmar fibromatosis is diagnosed at a young age, it is worth paying special attention to it - in this case it proceeds malignantly and has an unfavorable prognosis.

Dupuytren's contracture can be localized around all phalanges of the hand, but the third, fourth and fifth fingers are mostly affected. The lesion can affect both one finger and several adjacent ones.

The disease is named in honor of the French surgeon Guillaume Dupuytren, who first described this pathology in the XIX century.

Causes

To date, the reasons that lead to the development of Dupuytren's contracture are not definitively defined. Doctors distinguish several factors, the presence of which can provoke the degeneration of the palmar aponeurosis into fibrous cords and adhesions.

These include:

• Abuse of alcohol and tobacco products.
• Diabetes mellitus in the anamnesis and other metabolic disorders in the body. Also important is the hormonal changes.
• Traumatic damage to the brush, excessive vibration load on the brush.Handwork is NOT the cause of the development of this disease!
• Weighed heredity associated with genetic individual features of the structure tendon apparatus of the hand (in 30% of cases in the family suffering from this ailment had a palmar fibromatosis).
• Neurological disorders: first of all, defeat and infringement of the nerve fibers of the upper limb.
• Age and sex of the patient. The older the patient, the more likely the development of contracture is, especially in men.

Symptoms

The symptomatology of Dupuytren's contracture is very characteristic.

For an experienced specialist, it is not difficult to determine the diagnosis: the movement in the phalanx of the finger is severely limited, and on the inside palm surface is visualized and palpated nodal condensation in the area of ​​the affected finger (pathologically altered fascia palms).

In order not to start the disease, it is necessary to know how the symptoms develop in the development of this pathology.

It all begins with the appearance of a dense nodule in the area where the metacarpal bones are transferred to the phalanges of the fingers at the level of the metacarpophalangeal joints.

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Soreness is insignificant, only at a palpation directly most education, and more often painful sensations at early stages are absent.

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Mobility in the phalanx is limited - the function of extension of the finger is violated, but not critical. The patient can, although with little effort, unbend the injured finger.

Further education increases, transforming into a kind of subcutaneous lines (strands), and captures the nearby phalanges of the fingers. Increases in the function of extensors. Visually, the fingers are constantly in a bent position: inside the palm.

In severe cases painful sensations appear in the affected area (often with irradiation into the shoulder region), contracture extends to all phalanges of the fingers. Often there is complete immobilization of the joints - ankylosis.

The skin of the palm wrinkles and coarsens, the adhesive bands are clearly visible, especially when trying to unbend fingers.

To determine the presence (or absence) of the underlying symptom of the disease, perform a small self-diagnostic test. Place the palm (inside side) on a flat surface.

Even if, with efforts, you will be able to fix your fingers in a horizontal position, this indicates the beginning of the development of pathology.

Degrees

There are three degrees of development of the disease, according to which the specialist determines the amount of necessary treatment:

• The first degree. Subcutaneous formation (node) does not exceed 1 cm in diameter, with palpation there may be a slight soreness. The flexor and extensor functions are almost unaffected. Mobility in the joints of the pastern and phalanges is preserved.
• The second degree. The node, which has a rounded shape at the first degree, is transformed into a scar stripe - a cord, with an obvious transition from the palmar surface to the phalanx of the affected finger. The skin in the place of appearance of the strand changes: the skin becomes rough, often hyperemic. Mobility in the joint of the affected phalanx is disturbed, the finger is in a bent position to the inner side of the palm at an angle (from 30 to 90 degrees). The extensor function is broken.It is at this stage of the disease is a kind of deadline (the last term) to see a doctor for help.In more advanced cases, it is almost impossible to restore the brush functions.
• Third degree. The fibrous cord extends to the entire finger (it can reach the nail phalanx), the skin wrinkles, forming folds around the cicatricial changes. Severe tenderness is noted. Movement in the joints of the finger is severely impaired. In metacarpophalangeal joints there is a contracture with possible development of ankylosis, in interphalangeal joints there is a violation of mobility of varying degrees: from partial restriction of motion to complete immobilization. With the third degree of disease, the patient's quality of life deteriorates significantly, which can lead to disability.

Some specialists distinguish the fourth degree of palmar fibromatosis, in which there are lesions of several fingers, the fusions of adjacent fingers grow into one giant scar.

Surgical interventions with such a severe lesion do not work. Fingers are collected in a fist, the ability to unbend them completely.

This form leads to disruption of the normal operation of the hand, the inability to use it as a "working" tool, and ultimately - to the disability of the patient.

Diagnostics

Diagnosis of this disease is not difficult and is based on the following data:

• Hereditary anamnesis (whether relatives had similar diseases).
• Anamnesis of life: the presence or absence of bad habits, the resulting injuries.
• Objective examination of the patient with palpation of education on the palm.
• Assessment of the amplitude of movements of the affected phalanges of the fingers (if the amplitude is reduced, we can speak about the presence of fibromatosis).

The diagnosis is made clinically. Any special laboratory and instrumental diagnostic methods for this disease are not applied.

Assess the probability of progression of this pathology in most cases is quite difficult.

Often Dupuytren's contracture proceeds latently, without complaints and bright external manifestations in the palm of your hand: Movement in the joints of the phalanges is broken insignificantly, and the nodule is small and does not deliver discomfort.

In the future, against the backdrop of such a slow process, there can be a significant sharp deterioration. Therefore, in the presence of the above-described symptoms of palmar fibromatosis, it is necessary to immediately apply to medical professionals.

Treatment

Depending on the degree of the disease, conservative and surgical methods of treatment are used. The main method at present is surgical intervention.

Conservative treatment performs a more function of corrective and preventive therapy aimed at preventing the development of worsening of an already existing disease.

At the initial stages of pathology apply:

• Various types of therapeutic massage and gymnastic exercises aimed at stretching the muscles and the fascial layer.
• Physiotherapeutic procedures (thermal baths for hands, UHF heating).
• Fixing dressings. Special langets are used, which are dressed for the night and fix the phalanx for extension.
• Hormone therapy in combination with analgesics. Such a therapeutic blockade will help to remove the pain syndrome for a long time.

All these methods will not eliminate the contracture completely, but will help stop the further development of the pathological process.

Recently, a very effective method of treatment is the therapy with collagenase. It has the ability to resorb scars (splitting protein).

The drug is injected directly into the fibrous band, resulting in its resorption. The technique is very promising, as it allows you to unbend the injured finger the day after the injection.

This drug and method has only recently been applied, and there is still no evaluation of long-term positive results.

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Therefore, to restore mobility in the hand, "classical" radical treatments are used, which are used if the angle of bending of the phalanx is 30 or more degrees.

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According to the tactics of treatment, an open operation is distinguished, under which a cut of the skin of the palm is made, is removed scarring (completely or partially), and closed, when a fibrous component cuts the needle through skin. The result of these two types of surgery is one - the finger in one way or another unbends. The choice of treatment tactics is determined by the doctor, taking into account the evaluation of the general condition, age and stage of the process.

1. Advantages of open access. The surgeon can see the edges of the fibrous strand that allows performing the operation in full. Disadvantages - the presence of a developed innervation in the palm of your hand. If the nerves are damaged, the sensitivity of the fingers will be compromised, although the flexor and extensor functions will be fully restored.
2. The advantages of closed access. Malotravmaticheskaya operation, with a minimum of complications. Disadvantages - frequent development of relapses in a short time.

Try to find an experienced, "verified" doctor, because with the apparent ease of surgery, the consequences of the error can be very deplorable.

In severe cases of the flow of palmar fibromatosis (severely neglected contractures) surgeons can apply arthrodesis (motionless joint with fixation of the phalanx in one position) or amputation, especially if the nerve plexuses are damaged during open operation.

After surgical operations, in most cases the brush function is restored completely.

However, one must be prepared for the fact that in a few years (usually 5-10) a second operation may be required.

Having completed the surgical treatment, the patient will undergo a rehabilitation period that corresponds to the conservative treatment scheme described above.

The main condition for successful rehabilitation is the wearing of a special tire, which will allow for a better extension of the finger. The timing of its application is determined by the doctor - from several days to a month or more.

Which doctor heals

Dupuytren's contracture is the basis of carpal surgery. Traumatologists-orthopedists are engaged in treatment of this disease. If surgical intervention is required, in addition to orthopedists, this surgery can be performed by plastic surgeons who have experience in brush operations.

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A source: http://www.knigamedika.ru/kost/myagkietkani/kontraktura-dyupyuitrena.html