Arm and hand pain: Dupuytren’s Contracture


Arm pain, Hand pain, Uncategorized / Thursday, April 22nd, 2010

dupuytrens1Dupuytren’s Contracture is a condition in which the hand curls up into a claw. The beginning stages can be painful. Often genetically inherited, steroid or enzyme injections can help and the contracture can be released surgically if it gets to a critical point. The effects can be mitigated with specific deep tissue work like Neuromuscular Therapy.

Some causes are genetics, trauma to the palm, repeated cupping or grasping with the hand, and conditions like diabetes or alcoholism. What happens is that the palmar fascia shrinks and thickens, often forming bumps and then taut bands of tissue mostly on the pinkie and ring finger side of the palm. The fingers close up slowly and need to be opened up with manual treatment to prevent the eventual loss of function.

palmaris-longus-trpAs a Neuromuscular Therapist, I am very interested in a Trigger Point in the palmaris longus muscle in the forearm that connects to the palmar fascia. Contraction of that muscle can cause a similar clawing of the hand and referred symptoms in the palm that approximate true Dupuytren’s Contracture.

Treatment involves pressure release of the palmaris longus and finger flexor muscle bellies in the forearm, warming and lengthening the fascia and the flexor tendons in the palm with stretching and massage techniques, and treating all of the small muscles in the palm, including the palmar-brevispalmaris brevis that attaches to the fascia. Specific pressure on the thickened nodules helps to disperse them.

Prevention of recurrence requires limitation of activities using anything that must be grasped in the hand. Carpentry or gardening hand tools, a walking cane, a sports racquet, and extended tense gripping of a computer mouse or pen can activate or perpetuate symptoms.

For home maintenance, warming and stretching the hand helps. Spread the fingers then press the fingers of both hands together to increase the range of motion. Massage with slow deep strokes from the wrist outward to the fingers. Press deep into the palm. Stretch the fingers and wrist backward slowly, holding for two seconds and repeating 10 times.

This is a series on arm and hand pain from my Neuromuscular Therapy center near Boston. If you missed the beginning, go back to the “Checklist of Causes.”

3 Replies to “Arm and hand pain: Dupuytren’s Contracture”

  1. I was interested in your article of April 22, 2010, re. dupuytren’s contracture, with which I have just recently been diagnosed (including the often accompanying Garrod’s knuckle pads).
    Apart from that I am a healthy, active, 60year old woman, non-diabetic,etc – and drink only small amounts of wine.
    I work hard in my large mature garden (many hedges, trees, shrubs, lawn, so need to use secateurs, hedgecutters, edge strimmer, lawnmowers etc.
    However, even carrying a bag of shopping has become difficult (!) as I’m losing strength in my grip.
    Your article is of interest because, unlike some which I have begun to research, you mention pain; and the related arm muscle/s.
    I am experiencing a sustantial amount of pain and tenderness, not only in my hands, which are also stiff – but along my arms too – muscular aching – as if they have been punched and strained, when in fact I have done nothing out of the ordinary (for me). Even if I take a day or two ‘off’ from the garden work, this discomfort persists, and can keep me awake at night.
    Your article helps me to understand (I think!) why there are pains in my arms, relating this to the contracture in the hands.

    Does this arm pain suggest that this ‘trigger point’ palmaris longus muscle is primarily causing the hand/finger contracture?
    Or is it that the contracture in the hand is causing pain to travel up the arm? Well, I’m too far from Boston to make direct contact. (Although I did pass through in 1974 on my way to Maine, where I sent that summer volunteering in a summer camp!)

    I am lefthanded. The garrod knuckle pads are most pronounced on the index and middle finger of the right hand, while my left hand pinky is bent most, at present. (The index finger on the left hand also has a pronounced arthritic joint on the first digit – just to make matters worse!

    We have lived in our family home for all of 60 years.
    Has the time now arrived when we need to consider our future in a smaller property? – for even typing this is uncomfortable!
    I’ve answered my own question, I know, but should I prepare for this condition developing and thus (most likely?) preventing me from continuing with, particularly, my gardening/maintenance work?

    I understand that you may not wish to offer an (informal) opinion, but I’m trying to understand this condition better, as it may be the catalyst for some major changes for me!

    Thank you for your helpful article. I shall continue to research thi unfortunate condition – while its raining…again…

    Yours sincerely,
    Heather

    1. Hello Heather,
      In my opinion, without the benefit of meeting you and examining your arms and hands, it sounds as if you have a Repetitive Stress Injury (look up RSI in my blog for more information and tips for self-treatment). Reading about your love of gardening and all the hard work you do there to keep it beautiful, it sounds like the muscles in your forearms have become too tight and need treatment to prevent further pain. I have suggestions in the posts you’ll read, but nothing can substitute for good deep tissue therapy. Sometimes the muscles get so tight over time that they can’t loosen up without manual intervention.
      It sounds like the Dupuytrens is secondary to the repetitive stress in your arms. Pay attention also to the muscles in your chest, shoulders and neck. They all will need attention in the process of healing so you can stay at home for longer in your garden. You may need to spend an hour a day in self-treatment and manual therapy to get past this hump.
      For the Dupuytrens, follow the directions in the blog faithfully to help with the contracture. You can delay the progress of this condition if you are consistent. If necessary, submit to the surgery, but not till you get to that critical point where it is necessary within the specified short window of time. Learn about that critical point and be prepared with a connection to a really good surgeon to be ready to go in to get the surgical release.
      Let me know if I can help in any other way.
      Best to you,
      Christina

      1. Hello Christina,
        Thank you so much for your swift and helpful reply. I shall read your other articles…and do my best to pay attention to what you advise.
        Heather

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