A knot on the palm under the skin. Treatment of Dupuytren's contracture at home. Selective fasciectomy without general anesthesia

Dupuytren's contracture is a specific pathology in which the palmar tendons turn into scars. Due to the pronounced proliferation of connective tissue, the tendons become shorter, the fingers (one or more) cease to fully extend. Contracture develops, causing the functionality of the hand to be severely impaired. The true causes of the disease are unknown, but it has been found that it is non-inflammatory in nature.

The patient can independently identify the presence of Dupuytren's contracture - a dense, knotty connective tissue cord appears in the area of the affected tendons, and the hand ceases to function to the same extent.

Traumatologists and orthopedists are trying to treat Dupuytren's contracture with conservative methods, but the disease is prone to inevitable progression, so surgical intervention cannot be avoided.

Dupuytren's contracture is also called palmar fibromatosis.

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In the field of traumatology and orthopedics, Dupuytren's contracture is considered a fairly common disease - according to various sources, the incidence is 3-10% of the total number of all pathologies in this area, excluding herbs.

The disease develops more often in middle-aged men – 32-45 years old. Younger people are less likely to be affected, but if this happens, Dupuytren's contracture progresses faster, and irreversible changes can occur at an accelerated pace. Women suffer 6-10 times less often than men, and the disease itself is easier and more favorable for them. In 50% of all clinical cases, the pathology is bilateral.

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The statistics of damage to the fingers due to Dupuytren's contracture are as follows: in approximately 40% of cases it affects ring finger, in 35% the little finger is affected, in 16% - middle finger, and 4-5% of cases occur on the first and second fingers.

The disease is very unpleasant, as the patient loses the ability to perform any work that requires the use of the entire hand, one or more fingers.

In mild cases, there is a slight limitation in extension, during which it is impossible to perform delicate work that requires “jewelry” movements - embroidery, drawing, and so on.

If the disease progresses, severe stiffness may develop, and in severe cases, ankylosis (complete immobility). At the same time, in pathological process One finger or several may be retracted. In the latter case, there is a risk of impairment of the functional abilities of the hand as a whole; it literally becomes a useless human appendage.

Causes of palmar fibromatosis

Due to the fairly pronounced prevalence of Dupuytren's contracture, many clinical cases have been described, and enough statistical data has been collected to draw conclusions about the dependence of the development of this pathology on certain factors. However, the true reason why the flexor tendons of the fingers begin to degenerate into scars and harden has not yet been clarified. The most reliable theories of the occurrence of pathology are considered to be:

traumatic;
constitutional;
neurogenic.

According to the traumatic theory, the occurrence of Dupuytren's contracture is preceded by violations of the integrity of the flexor tendons of the fingers - they are:

associated with medical interventions;
arise due to non-medical trauma.

Dupuytren's contracture most often develops in patients who have undergone some kind of medical intervention on the palms. It can be:

minor invasive (associated with penetration into tissue) manipulations;
full surgical intervention.

In the first case it is often:

extraction foreign body from the soft tissues of the hand (namely the palm);
– sampling of suspicious tissues for the purpose of subsequent examination under a microscope (in particular, when tumors appear and their malignant nature is suspected).

In the second case it is:

wide opening (limited ulcers);
suturing wounds of various types;
plastic surgery to restore the functional ability of the hand.

It is believed that during all the mentioned manipulations and operations, the flexor tendons of the fingers may be affected; the body reacts and, as compensation, “launches” the process of intensive growth of connective tissue, which ultimately leads to scar degeneration of these structures.

Even more often than after medical interventions on the hand, Dupuytren's contracture develops against the background of non-medical trauma - namely, some time after receiving wounds:

chipped;
cut;
chopped;
torn;
fragmented;

and others.

It is assumed that the mechanism of pronounced scarring in this case is the same as with Dupuytren's contracture, which arose after medical manipulations and operations. It was revealed that the pathology more often formed after festering wounds of the hand - however, the inflammatory process during the development of contracture was not noticed, scarring developed after complete cleansing wounds from pus.

According to the constitutional theory, the described pathology develops in people with a certain type of constitution (physique) and, in particular, with a certain type of connective tissue - it is prone to scarring, which results in Dupuytren’s contracture. The palmar aponeurosis is most susceptible to such scarring due to the peculiarities of its structure. The genetic basis for this theory has not yet been established.

The neurogenic theory of Dupuytren's contracture states that the pathology develops due to a lesion peripheral nerves. The essence of the theory: nerve impulses stop passing normally through the affected nerve endings, because of this, the flexor tendons of the fingers cease to receive normal nervous support, the regulation of processes in them at the tissue metabolic level is disrupted, as a result, an excess of connective tissue develops, from which scars are formed.

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The role of heredity in the formation of this pathology is considered. In 25-30% of all diagnosed cases of Dupuytren's contracture, it turned out that the patients had blood relatives suffering from the same disease.

In addition, a failure is considered as the cause of the development of this pathology various types exchange. But such diseases were not diagnosed in patients with Dupuytren’s contracture (for example,), and those minor disorders of protein, carbohydrate, fat or salt metabolism, which were identified from the data laboratory research, cannot be regarded as a trigger for the disease. Moreover, they were detected in people whose finger flexor tendons were physiologically normal.

– failure of carbohydrate metabolism due to lack of the hormone insulin;
hormonal disorders thyroid gland– (lack of hormones) and (their excessive synthesis);
impaired production of corticosteroids due to a disorder of the adrenal cortex.

But a direct connection between the voiced pathologies and Dupuytren’s contracture has not been proven - they could develop independently of each other.

Mechanical stress on them is suspected in cicatricial degeneration of the flexor tendons of the fingers. Most often it is observed when:

certain work activities – in particular, those associated with lifting and carrying loads;
practicing some sports - mainly weightlifting (lifting weights, hammer throwing).

But there are few cases of Dupuytren's contracture in such patients to suggest that physical stress on the palms and fingers provokes excessive development of connective tissue with subsequent scar formation.

Development of pathology

With Dupuytren's contracture, not only connective tissue elements are affected - changes in the skin of the hand can be observed.

First, foci of infiltration (thickening) appear in the tendons, which are noticeable only at the tissue level. Further, as the pathology progresses, such foci become larger and can merge or develop in isolation. In the affected area, the number of fibroblasts (these are cells that produce collagen and elastin) and fibrocytes (the actual basis of connective tissue) increases. The intercellular substance of the connective tissue (matrix) swells and becomes denser. There are more collagen fibers.

note

Scarring with Dupuytren's contracture can either be observed simultaneously in the tendons of all affected flexors of the fingers, or “stretch” over time - first the connective tissue fragment of one flexor is affected, then the other, and so on.

Symptoms Dupuytren's contracture

The clinical picture of Dupuytren's contracture is very characteristic; in most cases it is difficult to confuse it with symptoms of other diseases. A compaction forms on the palm in the form of a knot or subcutaneous cords (one or several). The extension of the fingers is limited.

Usually, initial sign Dupuytren's contracture becomes thickened in the area of the metacarpophalangeal joints of the IV-V fingers - in other words, a thickening appears in the place where the fingers are “attached” to the palm.

Subsequently, the formed dense node slowly but inevitably increases in size and then transforms: cords extend from it - first to the main phalanx of the finger involved in the pathological process, and then to its middle phalanx. Such cords seem to tighten the tendon - it becomes shorter, because of this, contracture develops - first in the metacarpophalangeal, and then in the proximal interphalangeal joint(the one that is further from the fingertip and closer to the palm).

The skin around the compacted node is also transformed. Their characteristics:

in terms of density - more dense, but elastic; as the pathology progresses, elasticity decreases;
in relation to the surrounding tissues - gradually fuse with them;
according to the relief - irregularities appear on the skin in the form of alternating bulges and retractions. They are formed due to the soldering of the skin to the underlying tissues.

When the patient tries to straighten the finger, the knot and cords become more pronounced, distinct, they are clearly visible and can be felt.

Pain syndrome is not typical for Dupuytren's contracture. Only every tenth of all patients complains of discomfort in the area of the palm and fingers. Characteristics of pain:

by localization - in the area of the affected palm;
by distribution - they can radiate (give) to the forearm, sometimes to the shoulder;
by nature – aching, tightening;
in terms of severity – tolerable;
by occurrence - pain is often associated with attempts to forcibly straighten the palm and perform any actions with the fingers.

During the pathology described, three are distinguished:stages:

first;
second;
third.

Characteristics of the first stage of the disease:

Characteristics of the second stage of the disease:

the cord thickens, becomes rougher and stiffer, more intractable, and spreads to the main phalanx of the affected finger;
the skin over the lesion also becomes rougher and fuses with the palmar aponeurosis;
in the affected area, depressions similar to funnels are formed, as well as retracted folds;
the affected finger (or fingers) is forced to bend at the metacarpophalangeal joint at an angle of 100 degrees; it is impossible to straighten it with the efforts of the finger itself.

Characteristics of the third stage of pathology:

the connective tissue cord extends to the middle phalanx of the affected finger (less often to the nail);
in the joint formed by the metacarpal bone and the phalanx of the finger, a flexion contracture develops, the finger in this location is bent at an angle of 90 degrees or less;
straightening the finger at the interphalangeal joint is problematic, the degree of restriction varies;
in severe or advanced cases, adjacent phalanges of the affected finger are located at an acute angle to each other;
against the background of such changes on the part of the phalanges, subluxation is possible, in difficult cases - ankylosis (complete immobilization with the formation of a claw-shaped hand).

The pathology is characterized by a progressive course; the rate of progression can fluctuate and often does not depend on any external factors: in some patients it lasts for years, in others – for several months (from the first signs of pathology to stiffness or even complete immobility). In some cases, a combined option is possible, in which progression is not observed long time, but then develops very quickly. Predicting the progression of Dupuytren's contracture is problematic.

Diagnostics

The diagnosis of Dupuytren's contracture in most cases is not difficult to make - the patient's complaints, medical history and characteristic examination results play a role.

Physical examination assesses:

Additional instrumental and laboratory methods Studies in the diagnosis of Dupuytren's contracture are usually not required.

Differential diagnosis

There is practically no need for differential diagnosis of Dupuytren's contracture due to the characteristic clinical picture.

Complications

The main complications of Dupuytren's contracture are:

hand deformation;
partial impairment of her functional abilities;
complete immobilization of the hand.

Treatment of Dupuytren's contracture without surgery and surgery

It is possible to radically rid the patient of this pathology only through surgical intervention. Conservative treatment is also used, but it can be effective in the most early stages diseases. As the disease progresses, conservative treatment is restorative and symptomatic; it is not possible to eliminate progressive Dupuytren's contracture with its help. But it can slow down the progression of the disease - in particular, the development of ankylosis.

Conservative therapy is based on the following:

physiotherapy;
exercise therapy complex;
massage;
fixing devices - often removable splints;
therapeutic blockades.

Physiotherapeutic methods that have proven themselves in the treatment of Dupuytren's contracture are:

laser therapy

and some others.

A set of exercises for the affected hand is performed under medical supervision, the goal is to increase the range of motion in the joints.

Massage is prescribed simultaneously with exercise therapy, its purpose is to stretch the palmar aponeurosis.

Removable splints fix the fingers in the extension position, thereby “accustoming” the tendons to the correct position. As a rule, they are attached to the hand at night and removed during the day.

Therapeutic blockades are performed for pain syndrome. In this case, hormonal drugs are used:

diprospan;
triamcinolone;
hydrocortisone

and others.

The drug is mixed with an agent used for local anesthesia and injected into the site of the painful node. Usually, positive effect One blockade is observed for 6-8 weeks. But hormonal blockades must be used with caution.

The indications for surgical correction of the described disease are as follows:

severe dysfunction of the affected hand;
progression of pathology;
household and work inconveniences that arise with Dupuytren's contracture (even if it itself is not very pronounced);
pain syndrome.

Most often, surgery is performed if a flexion contracture has developed with an angle of 30 degrees or more. The main objectives of the operation are:

excision of tissue that has undergone scar changes;
restoration of joint movements.

note

Operations to eliminate Dupuytren's contracture are reconstructive and take quite a long time, so they are performed under anesthesia.

A number of surgical techniques have been developed for Dupuytren's contracture. Their choice depends on:

location of scar tissue;
its severity;
the presence of adhesions of the skin to the underlying tissues.

During the operation, the palmar aponeurosis is completely or partially excised. If there are pronounced adhesions (they are often accompanied by thinning of the skin), then skin grafting with a free skin flap will be required.

After the operation, the hand is fixed for some time using a splint in a functionally advantageous position - with slightly bent fingers.

Some time after surgery, a complex of exercise therapy and massage are prescribed.

Prevention

Because real reasons The occurrence of Dupuytren's contracture is unknown, and no specific methods of prevention have been developed. The following actions and measures will help reduce the risk of this pathology:

carefully performing any medical manipulations on the palm and fingers;
avoidance of trauma to this area, and if there are injuries, their adequate treatment;
prevention of damage to peripheral nerves, and if it has already developed, its timely detection and treatment;
control of metabolic processes in the body;
prevention, timely detection and relief of endocrine disruptions;
dosing physical activity on the palm and fingers.

Forecast

The prognosis for Dupuytren's contracture is very different and depends on the severity and rate of progression of the disease. With timely surgical treatment and after using conservative methods, hand function can be restored.

In some patients (this applies to cases of early onset and rapid progression), a relapse of the pathology may occur. Basically, it is diagnosed within several years after surgery, less often - several decades. In this case, you will need to repeat surgical intervention.

Contracture– this is a condition when the mobility of the joints is limited, they bend with difficulty and with pain. This disorder is common to many ailments.

Types of contractures

Contractures appear as a result of diseases or after injuries. The most common non-traumatic diseases that cause contractures are age-related diseases: arthritis and arthrosis. Other diseases such as stroke, lack of blood supply and muscle inflammation, damage to peripheral nerves and even... hysteria also lead to joint stiffness.

Therefore, it is impossible to cure any persistent contracture without obtaining a diagnosis! However, together with the treatment of the underlying disease, which is always selective, there are also general means to combat contractures.

This is due to the fact that all these disorders have a common development path. The soft tissues of the musculoskeletal system need constant movement and cannot tolerate long periods of inactivity. Each of them responds with a characteristic breakdown. The joint capsule shrinks and then thickens. The muscles atrophy. Adhesions occur between the tendons and surrounding tissues. The most destructive result of any contracture is ankylosis of the joint, that is, complete loss of mobility.

If the injury (subluxation, sprain, bruise) was not severe, the body will cope with the damage on its own. Pain will help eliminate those movements that interfere with proper tissue healing. And gradually, as functions return to normal, pain limiters will begin to turn off. As a result, movements are disrupted for a short time, and a persistent contracture does not have time to mature.

Multiple microtraumas also cause contracture of the hand, called Dupuytren's disease. It may seem that if the injuries are “microscopic”, then the disease is easily treated, but this is far from the case! Of all the contractures, this is definitely the most dangerous.

Disease prevention

Dupuytren's disease usually occurs on the right hand in men over 40 years of age who have been employed for many years manual labor(primarily these are drivers of heavy-duty transport, tractor drivers, combine operators, turners, milling operators, mechanics). Repeated injuries lead to permanent damage to the tendons of the hand.

The fingers freeze in a bent position. And it becomes impossible to unbend them arbitrarily.

To prevent Dupuytren's disease, it is recommended to use gloves when working (especially with metal), and of the most dense fabric, as far as the fineness of your work allows. Even under mittens, use a softening and protective cream for your skin, which can be bought at any pharmacy. Without cream, cracks quickly appear, through which various damaging factors easily penetrate deep into the tissue. After working with materials that may leave aggressive substances, splinters, or all kinds of shavings on the skin, be sure to wash your hands with soap, or better yet, with a cleaning paste that can be bought at auto parts stores. Then wipe your palms with a sponge or soft cloth. A long and tense bent position of the hand (the driver holds the steering wheel) increases the risk of this disease. For every hour of such work, do gymnastics for at least 5-7 minutes, bending and straightening your hand.

Try to carefully protect your hands, do not forget about exercises and you can prevent this disease! A feature of the destructive process in tissues with Dupuytren's contracture is that it moves forward with extraordinary persistence. And even when a person changes jobs and starts conservative treatment, which helps cure all other contractures! In more than 90% of cases, surgery is necessary. But due to the great complexity and fragility of the tendon mechanism of the hand, it will only in rare cases restore its movements completely.

Movement for healing

Contractures that arise as a result of severe “one-time” injuries (such as fractures, dislocations) are also dangerous in their own way. Here, since the recovery is delayed, we choose for a long time for the injured limb a position that will dictate pain to us. And this is most often an incorrect and unnatural pose. The damaged joint quickly gets used to it. After a while, changing your position becomes very difficult. And after six to eight weeks of fixing the joint in the wrong position, the contracture can only be eliminated with the help of intensive and long-term conservative treatment or surgery.

That is why, after a serious injury, even if there was no fracture, it is necessary to fix the limb in the correct position as soon as possible, using a plaster splint or a tight bandage. Although fixation is not the best way out of the situation, such a problem as “developing” a seriously ill joint will cause even more destructive consequences...

However, there are universal principles for combating joint stiffness. Their basis is the use of two polar techniques: to give the joint rest in the correct position, but at the same time, start doing exercises as early as possible, that is, start kinesitherapy. This is the name for treatment through various types of joint movements.

Remember that the correct position (and not the one that the joint chooses itself), excluding swelling, ischemia, and tension of the joint capsule, can only be suggested by a traumatologist. For example, for shoulder joint- This is abduction of the shoulder by 45 degrees, flexion by 40 degrees and rotation of the limb inward by also 40 degrees. Even if you correctly calculate these angles, you still won’t design the fixing device yourself, and most importantly, you won’t determine the period during which it needs to be used. Therefore, never delay going to the emergency room after any severe injury or even, in your opinion, not serious, but one after which the stiffness for some reason does not go away.

Self-treatment is unacceptable

Let us now turn to kinesitherapy. The lion's share of patients' visits to a traumatologist regarding contractures is made up of such cases. The crooked joint is rubbed with hot ointment, alcohol is taken as a painkiller and the limb is jerked straight. The result can be multiple ruptures of muscles, tendons, ligaments and the need for surgery! Even if you don't hurt soft fabrics, contracture may develop due to reflex muscle spasm (muscle pseudoparalysis). It is difficult to treat, often “remembered” by the centers of nervous regulation and returns in the most dangerous way, say, while swimming in cool water.

At the same time, early prescription of physiologically based and correct movements is the best method prevention and treatment of contractures. Muscle contraction and joint movements enhance tissue nutrition and metabolism, preventing the onset of stiffness.

Treatment with movements for contractures is carried out in the form of passive and active therapeutic exercises. Using passive physical exercise, as well as massage, try to stretch contracted muscles and periarticular tissues. In the case, for example, of the already familiar Dupuytren's contracture, massage the muscles of the forearm close to the hand with stroking and rubbing movements. In the intervals between massages, using a healthy hand, passive development of the bent fingers of the affected hand is carried out. They are smoothly extended until the pain becomes tolerable. Each of your exercises with a total duration of up to 20 minutes should contain 5-6 massages and the same number of extension exercises.

Exercises and procedures

In case of any stiffness, things will go faster if you do the exercises in Warm bath and also after hot wrapping of a limb or mud applications. There are many useful additives that enhance the therapeutic effect of such baths ( aroma oils and extracts of eucalyptus, alfalfa, birch buds, lingonberries, chaga, nettle, pine needles; chlorides and sulfates of silver, potassium, magnesium, copper, sodium; Dead Sea salt).

But it won't hurt to go to Physiotherapeutic procedures. Indeed, with advanced contractures, healing substances must penetrate deep into the tissues in sufficient quantities. And this can only be achieved by using electrophoresis or another method to “push” molecules into tissues. In extreme cases, the doctor uses injections, for example, into formed scars. In order to soften scar tissue, the enzyme lidase is administered. Shown local application dressings with another enzyme - ronidase. They are applied to the scar area for at least two weeks. Aloe extracts, which contain powerful emollients, are also used for injections.

Active exercises in case of stiffness, they should not only stretch the contracted tissues, improve their metabolism, but also increase the strength of the stretched muscles, which counteract contracture. So, with flexion contractures, the extensor muscles “pump” and vice versa.

Resistance exercises on machines are especially helpful. With persistent and diligent use (at least 5 times a day, but each session no longer than 15-20 minutes, the total duration of classes is at least a month), those rubber or spring expander exercise machines or special balls for the hand, which are sold in sports stores, are sufficient. However, if you have the opportunity to work out in a physical therapy room, don't miss it! Even outdated block devices have the advantage that the load on the joint can be accurately dosed. This way, you can set yourself a new goal with each exercise, slightly raising the bar. By overcoming it, you will feel like you are defeating the disease, and this will become a significant psychological help in your recovery.

Folk remedies for contractures

hot pepper

We all perform many different tasks with our hands every day, manipulating large and small objects. Therefore, if the function upper limbs will be disrupted, it will immediately affect our rhythm of life. And if all human activity involves the need to make small movements with the hand and/or hold small objects in the hand, then diseases of the bones, joints and muscles of this area can become a real disaster. Exactly to such pathological conditions This also includes Dupuytren's contracture, which can be corrected by healers at home folk remedies.

Dupuytren's contracture is a fairly “popular” disease. But, despite the prevalence of this pathology, the true causes of its occurrence are still not clear to doctors. This disease is chronic, and its essence lies in the disruption of full mobility of the fingers, which is caused by abnormal growth of connective tissues, their degeneration into fibrous tissue and the formation of dense scars. With Dupuytren's contracture, the patient initially faces difficulty in straightening the affected finger (usually the ring or little finger or both); as the disease progresses, the fingers completely stop straightening, and the abnormal areas respond with pain.

Specialists official medicine It is proposed to treat this type of contracture using conservative or surgical techniques. But on this page “Popular about health” we will talk about how Dupuytren’s disease is treated with folk remedies.

Dupuytren's disease - treatment of contractures without surgery

Official medicine experts say that alternative methods of exposure can be a good addition to the classical conservative treatment.

Baths

Warm baths with various therapeutic components help warm up the soft tissues and make it possible to painlessly treat the affected areas.
So, shortly before a night's rest, you can prepare a bath with chamomile flowers. Pour forty grams of plant material into an enamel pan, add twenty grams of sea salt to it. Pour the mixture into a liter hot water, bring to a boil and keep on low heat for ten minutes. Cool the finished broth to thirty-five degrees, then strain and use for a bath. The optimal duration of such a procedure is twenty minutes. It needs to be done daily for two weeks.

Specialists traditional medicine It is also recommended to prepare a bath from vegetable peels. To do this, you need to collect peelings from three potatoes, one carrot and beetroot and a couple of medium onions. Wash such components under running water, pour into a saucepan and fill with four liters of water. Also add ten grams of salt and twenty drops of iodine to the container.

Boil this mixture for twenty minutes after boiling, then cool to thirty-five to forty degrees and strain. Dip the affected hands into the prepared decoction and knead the palm parts directly into medicinal composition for twelve to twenty minutes. Carry out this procedure every day for one and a half to two weeks.

Rubbing

Speaking about the treatment of Dupuytren's contracture with folk remedies, one cannot fail to mention rubbing the palm and fingers of the affected hand using tinctures prepared at home. An excellent effect is obtained by using tincture with kerosene and pods. To prepare it, you need to combine three hundred grams of oil and kerosene. Pour these ingredients into a glass container and stir. Grind the red pepper pods thoroughly (seven to ten pieces). It is best to use a blender for grinding. Add pepper to the kerosene and oil mixture. Infuse the medicine in a fairly cool place for twelve days, then strain. The finished tincture should be rubbed on your brushes three times a day. Afterwards, you should wear warm gloves or mittens - they will ensure optimal heating of the soft tissues. This therapy is carried out until finger mobility improves.

Also at home, contractures are rubbed with tincture from. To prepare such a remedy, twelve to fourteen chestnuts should be prepared. Peel them, wrap them in a towel and break them into small pieces with a hammer or rolling pin. Pour this raw material into a glass jar and fill it with a bottle of vodka. Shake the mixture several times and leave it under a nylon lid for three weeks. Use the strained tincture to rub your brushes shortly before your night's rest. The optimal duration of such treatment is two weeks. If necessary, the course of rubbing can be repeated.

Compresses

They also try to cure Dupuytren’s disease without surgery using various compresses. To prepare one of them, you need to combine fifty grams of buds with a bottle of vodka and leave for one and a half weeks. Strain the finished tincture.

Take fifteen seeds, brew a glass of boiling water and heat to a boil over low heat. Leave the product to infuse for an hour, then strain.
Grind fifty grams of horseradish root on a grater.

Combine a tablespoon of each prepared component (infusion, tincture and horseradish root) and apply as a compress to the affected area. The duration of this procedure is half an hour, no more.

Before you use folk remedies for contractures, you should consult your doctor.

It is a non-inflammatory disease, the essence of which is cicatricial degeneration of the tendons of the palms. Its other name is palmar fibromatosis. The disease begins with the connective tissue growing, the tendons becoming shorter, and the process of straightening the fingers becomes more difficult. Over time, the hand partially loses its functions - the development of flexion contracture reaches its maximum values, and a dense knotty cord appears in the area of the tendons affected by the disease.

On initial stages diseases limiting the mobility of the affected finger (or fingers) are insignificant. The progression of the disease leads to their stiffness or complete immobility(ankylosis). Modern medicine The causes of this disease are unknown. Early diagnosis The disease allows it to be treated with conservative methods, however, in most cases, the development of Dupuytren's contracture cannot be stopped. The only treatment option is surgery.

The ICD-10 code for Dupuytren's contracture is M72.0.

Dupuytren's contracture is an overgrowth of connective tissue in the area of the flexor tendons of the fingers (one or more). The area where the process is localized is the palm. The cause of this disease has not yet been clarified. As a result of its development, the ability to bend one or more fingers is gradually limited and their flexion contracture is formed.

Treatment of the disease at its early stage can be conservative, however, positive results can only be achieved through surgery.

Dupuytren's contracture is considered one of the most common orthopedic and traumatological diseases these days. And most often it occurs in middle-aged men. According to medical statistics, 40% of the fingers affected by the disease are ring fingers, 35% are little fingers, 16% are middle fingers, 2-3% are first and second. In 50% of situations, the disease is bilateral.

In women, Dupuytren's contracture is diagnosed 6-10 times less often and the prognosis of the disease is quite favorable. In young people, the course of the disease is more progressive than in older patients.

Etiology

The occurrence of the disease is in no way associated with a violation of salt, protein or carbohydrate metabolism. The theory of the onset of disease development against the background diabetes mellitus, put forward today by some medical luminaries, also has no basis.

But the traumatic (consequence of an injury), constitutional (structural features of palmar neurosis, inherited) and neurogenic (pathology of peripheral nerves) theories have both supporters and opponents. Moreover, the constitutional theory has a right to exist - 25-30% of the sick have relatives affected by the same disease.

The first signs of the development of the disease

The clinical picture of Dupuytren's contracture has specific symptoms - there is a pronounced thickening on the affected palm. It is formed by a knot and subcutaneous cords (one or more) and limits the ability to extend the finger (or fingers).

The first sign of the onset of the disease is the appearance of a lump on the palm, in the area of the metacarpophalangeal joints there are 4-5 fingers. Next, the dense formation begins to grow and increase in volume. Over time, cords begin to extend from it to the main and middle phalanges of the affected finger. The first contracture is formed in the metacarpophalangeal joint, the second - in the proximal interphalangeal joint. The skin around the node thickens and begins to fuse with adjacent tissues, forming bulges and retractions. As soon as you straighten your finger, the knot and cords appear more clearly.

For Dupuytren's contracture, the presence of pain is uncharacteristic - the presence pain Approximately 10% of patients complain. This type of pain radiates to the forearm or shoulder.

But what distinguishes Dupuytren’s contracture from other diseases is its progressive course. Moreover, the rate of development of the disease can be completely different and has no objective dependence.

Three degrees of Dupuytren's contracture

Depending on the symptoms of the disease, there are three main degrees:

I degree characterized by the appearance on the palmar side of the hand of a dense nodule, the diameter of which is 5-10 mm. And the formation of a cord (painful upon palpation) - it is also located on the palm and reaches the area of the metacarpophalangeal joint.
II degree– the cord becomes coarser, becomes more rigid and begins to spread to the main phalanx. The skin of the palm also becomes rougher - fusing with the palmar aponeurosis, they form retracted folds and depressions in the form of funnels. The finger (or fingers) affected by the disease is in only one position - it is bent at the phalangeal joint at an angle of 1000. It is impossible to straighten it.
III degree– spread of the cord to the middle and (less often) nail phalanges. Flexion contracture in the metacarpophalangeal joint is clearly expressed and makes an angle of less than 900. Extension of the affected finger is limited, its degree depends on the severity of the disease. In the most difficult situations, the phalanges are located at an acute angle relative to each other, and their subluxation or ankylosis is diagnosed.

The rate at which Dupuytren's contracture will progress cannot be predicted. In some cases, a slight limitation of mobility can persist for decades, in others, not even six months pass between the appearance of the first symptoms and the development of stiffness. There are also options in which a long-term stable course suddenly changes to immediate progression.

Diagnostics

The basis for making a diagnosis of Dupuytren's contracture is the patient's complaints and the clinical picture characteristic of this disease. During palpation, the doctor identifies the presence of nodes and cords, and the specialist also assesses the range of motion in the joint.

For additional laboratory and instrumental studies There are no grounds capable of confirming the diagnosis.

Treatment options

Treatment of Dupuytren's contracture falls on the shoulders of traumatologists and orthopedists. The doctor decides whether it will be conservative or surgical. When choosing a method, it is primarily based on the severity of pathological changes.

The effectiveness of conservative therapy (treatment of Dupuytren's contracture without surgery) can be noticeable only in the case of the initial stage of the disease. At this stage of the physiotherapy , use of removable splints, fixing the fingers in an extended position, and performing special exercises, aimed at stretching the palmar aponeurosis, can give certain results.

If the patient has persistent pain syndrome the doctor prescribes therapeutic blockades using hormonal drugs– diprospan, triamcinolone, hydrocortisone. A solution of the drug mixed with a local anesthetic is injected into the affected area. To where the knot formed. The blockade is quite effective - its effect lasts from 6 to 8 weeks.

However, application hormone therapy requires special care. In addition, the use of conservative methods will not help defeat the disease. They can only slow down the development of contracture. The only option to overcome the disease is surgery.

Indications for surgical intervention are the presence of flexion contracture (angle > 300) and pain, limitation of movements, difficulties with self-care and performing professional tasks.

During the operation, scars of altered tissues are excised and the patient is completely restored. physical activity joints. In the case of a severe form of the disease and in the presence of long-standing contractures, the patient is offered arthrodesis (fixation of the joint in a stationary position) or amputation of the finger. Post-traumatic contractures of the metacarpophalangeal joints are especially difficult to treat.

Reconstructive surgical interventions are performed under general or local anesthesia. If changes in the skin and palmar aponeurosis are pronounced, the operation will be lengthy. It is done under general anesthesia.

There are several options for incisions when performing Dupuytren's contracture surgery. Most often, the patient is given a transverse incision in the area of the palmar crease, combined with an L- or S-shaped incision palmar surfaces main phalanges of damaged fingers. The choice of one method or another is influenced by the location of the scars.

During the surgical procedure, the palmar aponeurosis is excised - completely or partially.

If, as a result of thinning of the skin, extensive adhesions have formed, there is a need for dermoplasty - suturing the wound with a free flap of skin and draining it with a rubber graduate. After the operation, a tight pressure bandage is applied to the patient’s palm, which prevents blood from accumulating and new scar changes from developing. And they firmly fix the hand with a plaster splint, leaving the fingers in a comfortable position. After 10 days, the sutures are removed.

Subsequently, the patient is assigned to perform the complex therapeutic exercises aimed at restoring full movement in the fingers. If a recurrence of Dupuytren's contracture occurs, the patient will not be able to avoid repeated surgery - a relapse may occur after several years or even decades. And its main reason is the early onset and rapid progression of the disease.

Read about treatment without surgery for Dupuytren's contracture. About 3% of the world's population suffers from this pathology. More often it occurs in able-bodied men after 40 years of age; the hands become deformed and lose their functions.

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The site provides background information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor. Any drugs have contraindications. Consultation with a specialist is required, as well as detailed study of the instructions! .

Modern treatment without surgery

Despite the seriousness of the disease, Dupuytren's contracture can be treated with conservative treatment methods.

To achieve this, various procedures are carried out that can relieve pain and ensure the restoration of normal limb functions.

When prescribing treatment measures, the following are taken into account:

Reason for appearance;
Location of scars;
The degree of tissue damage;
Patient's age.

Here is a list of treatment procedures to alleviate the condition of patients and accelerate the restoration of joint function:

Treatment with painkillers, hormones, NSAIDs;
Therapeutic blockades with the introduction of drugs into the joint cavity in the area of the nodes in the palm;
Manual therapeutic procedures for joints and muscles, UHF, physiotherapy and types of massage with elements of self-massage.

Drug therapy includes:

Glucocorticosteroids in the form of injections into the area of the node, drugs - diprospan, dexamethasone, kenalog, which help reduce pain;
Xiaflexa is a combined drug, administered by injection, which has a destructive effect on collagen;
Applications with lidase, trypsin, rodinase to the affected areas, they help slow down tissue degeneration, soften the peri-scar tissue, and relieve tension in the hand.

Physiotherapy procedures using mud and paraffin baths, electrophoresis, and phonophoresis for the hands help simultaneously warm up problem areas and provide a mineral “feed” for the sore joint.

All these procedures are effective at the initial stage of contracture development.

What is the disease

Dupuytren's contracture is named after a French doctor who described it in the early 19th century clinical picture diseases. It is otherwise called palmar fibromatosis.

With this disease, the tissue of the tendon of the palmar aponeurosis degenerates, gradually shortens, turning into a scar in the form of a tourniquet.

The palmar aponeurosis occurs in the form of a triangular plate, located under the skin of the palm. Benign compaction of the aponeurosis takes a long time to develop, in some patients it even takes up to 8 years.

At first, patients mistake pathological nodes for calluses. The seal limits the extension of one or more fingers, usually the little and ring fingers.

Subsequently, they curl up and remain in this position. Although the disease is not fatal, able-bodied men engaged in physical labor suffer due to dysfunction of the hand.

Causes of contracture

Scientists do not have the same opinions about the mechanism of the appearance and development of this insidious disease.

The possibility that heredity plays a role is supported by the fact that all family members who suffer from palmar fibromatosis were found to have a gene that was absent in healthy people.

But not everyone who has this gene develops the disease. The onset of the disease probably requires that the body be exposed to some risk factors.

Based on the research of scientists and the observations of doctors based on the anamnesis of patients, we can conclude that the risk factors are:

Professions that involve heavy manual work (loaders, porters, long-haul drivers, mechanics, carpenters, etc.);

Arm injuries and hand injuries that caused tendon strain;
Smoking, alcohol abuse;
Gender and age, most people get sick after 40 years of age;
The presence of kidney and liver diseases, diabetes, epilepsy, which cause disorders in connective tissues.

If the disease is detected in the early stages of development, you can get rid of it using conservative treatment methods:

Medicines;
Massage;
Physiotherapy;
Therapeutic exercise.

Along with these treatment methods, traditional medicine can be used.

How does this pathology manifest itself?

Dupuytren's contracture is recurrent chronic disease. The connective tissue of the palmar aponeurosis under the skin during contracture degenerates into fibrous tissue, forming dense scars.

Scars gradually cause damage to the joint capsules and tendons. The skin becomes lumpy due to nodules underneath.

There are 3 known types of such lesions:

Palmar;
Finger;
Mixed.

During the first stage, lumps in the form of nodules appear under the skin in the palm area, which are initially mistaken for calluses. No one suspects the onset of the disease, because the fingers move and there is no pain. Sometimes you feel pain when you touch it.

The second stage is accompanied by the following signs: the seals will be rougher, depressions like a funnel and retracted folds will appear on the palm. Extension movements of the hand will be limited by about 30 degrees, the patient’s finger will not bend.

Characteristic signs of the third stage of the development of the disease are the following symptoms: the fingers are involved in the process, the movement of which becomes limited by 30-90 degrees.

The sore finger does not straighten and is constantly in a bent position. The patient feels pain in the hand. The function of the affected arm is impaired.

The fourth stage is characterized by more pronounced pathological changes.

Joints and tendons are involved in the process, they contract even more, and strands appear on the palm of the hand.

The affected fingers almost do not straighten and are in a position of more than 90 degrees to the palm. The brush loses its functions and becomes deformed.

In some cases, as the nodule enlarges, connective tissue grows. It begins to compress the blood vessels and nerve bundles, and then it is necessary to amputate the finger.

Sometimes they form a fixed joint, as a result of which the fingers cannot bend at all.

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Effective ointments

When conducting complex treatment For contractures, ointments and medicinal gels are used to relieve pain and relieve tissue swelling. Scars under the influence of ointments will be soft and the skin will be elastic.

Patients note effectiveness after using such ointments.

Contractubex, it has the ability to slow down the formation of scar tissue and stimulates the production of collagen.
Kelofibrase - a cream that softens scars, well maintains water balance in skin. Used against inflammatory processes and for the prevention of stretch marks after operations.
Kelo-cote silicone gel from an American company, which helps in the treatment of various scars after surgery.
Fermenkol, which is used both before surgery and after open type contracture surgery, after needle aponeurotomy. Effective together with electrophoresis and phonophoresis in the recovery stage.
Dermatix - applied after surgical operations after wound healing.

We cope at home with folk methods

Traditional medicine has many means for treating “chicken's feet” (as contracture is popularly called) at home.

They can stop further progression of the disease in the initial stages of development.

To treat Dupuytren's contracture at home, use:

Compresses;
Rubbing with ointments;
Baths with decoctions.

Options for preparing a healing ointment

A healing ointment that is prepared by mixing fresh butter with beeswax is effective. It softens scars and rough skin on the palm, relieves irritation, itching and inflammation.

To prepare it, mix 250 g of butter with 100 g of beeswax and 100 g of pine resin. The mixture is boiled for 10 minutes, adding dry celandine 30 g, boiled for another 5 minutes, half a liter is poured into it St. John's wort oil. After bringing to a boil, remove from heat, cool and filter.

Help from home medicinal baths

Use baths with vegetable peelings. To do this, place peelings of beets, potatoes, onions and carrots in a bowl, pour in water and add a spoonful of salt with 20 drops of iodine (calculated for 5 liters of water). The whole mass must be cooked until the vegetables soften.

After the broth has cooled to body temperature, the sore hand is lowered into it and held for 10 minutes, making movements to straighten the fingers. After taking a bath, wrap your hand in a warm soft towel.

Conducting effective massage sessions

Patients respond well to massage using butter. Apply fresh butter to the affected hand, then make stroking movements for about 5-6 minutes, rubbing the palms and fingers until mild, tolerable pain appears.

You can use aloe juice. For this purpose, a dense, freshly picked leaf is suitable, which should be thoroughly mashed until juice is obtained. Lubricate the hands of sore hands with the juice that appears and hold for several minutes.

Useful gadgets in the fight against a running process

Healers offer lotions with an infusion of pine or spruce needles with the addition of their cones. Prepare an infusion of 100 g of pine needles in a glass of hot water. A cloth soaked in the infusion is applied to problem areas of the hand.

A glass of kerosene is mixed with a glass vegetable oil with the addition of 7-10 pods of hot pepper, passed through a meat grinder. The infusion will be ready in about 10 days. After filtering, it is rubbed into the affected areas with gentle stroking movements.

Tincture of crushed chestnut fruits 300 g in alcohol (0.5 l) also helps well with contracture. Ready in 2 weeks. Before going to bed, lubricate your hands with the resulting tincture.

The need for surgery

There are several methods surgical treatment. When the disease reaches stage 3 of development, at which the contracture of the finger acquires an angle of more than 30°, this indicates that surgical intervention is necessary. Although some doctors suggest surgery at stage II.

In our country, the segmental excision method is used during surgery for Dupuytren's contracture. He is considered more the right technique when only the affected area of the aponeurosis is removed from the base of the palm to the place where it is attached to the finger.

When deciding on surgery, the patient's age and disease progression are taken into account. When a contracture is removed, the affected tissue is excised so that movement in the joint can be restored later.

The aponeurotomy procedure is performed under general anesthesia or local anesthesia. After excision of the tissue, the surgeon sutures the wound, then a tight sterile bandage is applied to the palm.

The finger is fixed with a functional splint in the position in which a healthy finger is usually found. The bandage is not removed from several weeks to several months, it all depends on the nature of the disease.

In severe cases, another surgical method is used, which is called arthrodesis. During arthrodesis surgery, the finger that is unable to move is fixed in the most advantageous comfortable position. It will not be able to move like a healthy finger, but it will not interfere with the sick one.

Medical equipment with strong optics has appeared in clinics; after microsurgical operations to remove contractures, complications are not observed.

They began to use needle aponeurotomy, in which the seals under the skin are pierced with an injection needle in different directions.

The fibers of the cord are damaged, the functions of the finger and hand are restored. The operation requires a lot of experience from the surgeon, because the nerves and tendons of the hand can be affected.

Rehabilitation in the postoperative period

When using needle aponeurotomy, rehabilitation measures can begin within a few hours; this method does not leave wounds or stitches. It is necessary to begin developing the hand with flexion and extension.

When performing an open operation, rehabilitation should begin after the sutures are removed:

After the operation, you need to monitor the joints that are not in plaster so that they are in motion, but in moderation.
On the first day after surgery, soft tissues and plaster are checked, and on the second and third postoperative days, the Redon drainage is removed.
On days 5-7 after surgery, the plaster splint is removed and the bandage is changed.
Patients should begin daily physical therapy.
2 weeks after the operation, the sutures are removed and the bandage is changed.
Once the stitches are removed, the bandage is no longer needed.
Begin to carry out regular (3-4 times a day) exercises with hands in cold water(you can even add ice). Cold helps relieve swelling and pain. Those who cannot stand the cold can exercise in warm water.
5 days after removal of the sutures, treatment of the postoperative scar begins.
Rub various ointments, for example, calendula ointment, several times a day. The scar softens, it becomes elastic, pain and sensitivity decrease.
You can pat the scar with a soft brush.
The entire period of patient's disability lasts approximately 4-6 weeks.

Rehabilitation must be continued medical procedures using gymnastics.

Physical therapy for the patient

Exercising is considered one of the effective ways contracture is eliminated, muscles contract, joints begin to move, increased flow occurs useful substances V connective tissues body.

During procedures physical therapy Extension movements are performed, the muscles of the hand are stretched and act against the compaction of the ligaments of the hand and fingers.

Using your healthy hand, you can work out the bent fingers of the affected hand, carefully straightening them and bending them until a slight pain appears.

Here are some simple exercises:

Snap the brush with each finger several times.
Squeeze all 5 fingers into a pinch 10 times. Hands are on the table, palms up.
Perform scratching movements on the surface of the table with your fingers, which are palms down.
Develops the hands by bending and straightening the fingers lying on the table.
Spread your fingers, hands lie palms down, return to the starting position. Repeat 10 times.

Exercises using a power expander give good results. For contracture, strength kinesitherapy is used, which is a synthesis of physical therapy and sports training.

Muscles with contracture are “dragged” into the pathology process.

And the work of the muscles can be controlled by both the doctor and the patient himself, giving the muscles a feasible load.

Therapeutic exercises can be done in rehabilitation period and for disease prevention. For example, it is easy to perform exercises to bend and straighten your fingers for 5-6 minutes until a burning sensation and compression appear.

With regular exercise, further progression of contracture can be prevented.

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