Dupuytren’s contracture: treatment of without surgery methods surgery
Dupuytren’s contracture: surgery or medical treatment without surgery?
Dupuytren’s contracture is one of the complex diseases that gives serious complications, and progresses to contracture of the tendons of the fingers.
Despite the breakthrough of modern medicine, the disease is still not losing its leading position, turning perfectly healthy people into helpless invalids. But the symptoms were first recorded in the mid-nineteenth century.
A. Kupper argued that the mobility of the fingers depends on the contraction of the muscles located on the surface of the palm.
But detailed clinical characterization gave the French surgeon Dupuytren G. in the thirties of the XIX century, he conducted clinical studies, which are based on all the achievements of modern medicine.
The disease now bears his name Dupuytren’s Disease.
The General concept of disease
At the international medical classification of diseases since 1974 Dupuytren’s Contracture belongs to the group of fibromatous.
The disease is characterized by the limited function of joints of the hand.
The limb loses its elasticity, and the hand is not fully bent and not compressed in the joints.
This is because the appear on the skin scar of education, they are tightening the skin that covers the tendon. Will become inflamed joints. The pain appear.
There are 2 types of pathology:
- passive (structural);
- active (neurogenic).
Usually the disease of education can be observed in the process of the ring finger or little finger. But the disease can spread to all fingers, gradually moving to the other arm.
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According to statistics young people are rarely confronted with this problem, but lately Palmar fibromatosis «started younger».
Especially among men who have symptoms of the disease appear more often than in women. Often the symptoms manifest in middle-age. If the disease manifested at a young age, she quickly progressing and severe.
At first the symptoms are slight, people don’t pay attention to them, there are small bumps at the base of the fingers that do not hurt.
If time does not pay attention to the symptoms, the disease will turn into severe form. Usually among the first symptoms is a large amount of time (months and years).
There are many theories, each of which can explain the causes of the disease:
- the result of the injury;
- disturbed endocrine system;
- neurogenic, are rare (1-3% of cases);
- bad habits of nicotine and alcohol dependence are independent risk factors for the development of this disease;
- often found in people with diabetes, and people are susceptible to epileptic seizures.
The generally accepted cause of the disease is a genetic predisposition.
According to this theory Dupuytren’s contracture is a disease that affects the connective tissue system, not isolated luminosities Aport. Often occurs as a result of injuries of locomotor apparatus.
Symptoms of the disease at different stages of development
Depending on the stage give off such symptoms pathology:
- Appear subcutaneous seal, which does not cause discomfort upon compression of the fingers. In the first stage, the patient still does not require surgical intervention.
- The patient feels discomfort in the wrist, the flexion of the fingers, this period can be limited to clinical treatment that helps to restore the grip.
- The deficit of extension of the fingers, the deformation process covers the surface of the palm. At surgery, complications can occur. Use radical methods of treatment for straightening the fingers. During operation, problems can occur. The skin loses its elasticity. Vascular nerves of the fingers are too tight. And because surgery is not always lead to positive results.
- Pathology increases. At this stage, the disease penetrates into the tendon system and joints. Surgical intervention is ineffective.
Diagnosed the orthopedist — the traumatologist. After hearing the complaint and will conduct a survey of the patient.
You need to determine the stage of disease development, which area already affected and to what extent the contracture affects the performance of the brush.
The doctor should ask the patient about his lifestyle harmful habits. It is necessary to determine whether the disease is hereditary.
Then the doctor examines the brush, as it is necessary to study the mobility of the fingers. During the consultation the doctor can determine the thickness of the Palmar fascia, which manifests itself in the form of nodules cones (the denser will be the education, the more time it will require treatment.)
At first, the nodules appear on the palm of your hand, gradually move fingers.
Methods of conservative therapy
Usually for the treatment of Dupuytren’s contracture apply two methods of clinical and surgical. When choosing a method of treatment it is necessary to consider the nature and symptoms of the disease. The methodology was developed leading traumatologists, orthopedists and surgeons.
Conservative method used in early stages of the disease:
- therapeutic exercises, she helps you develop the brush of hands;
- corrective procedures (splint or plaster cast), you must lock the fingers in a straightened position. Usually longyou the bandage is applied before sleep, the hand should be at rest;
- warm baths;
- injection, usually steroid drugs.
With clinical therapy it is possible for some time to contain the spread of the disease and slow down the formation of a dense cones on hand.
The fingers are movable. But this is only a temporary measure, over time, it is necessary to resort to surgical intervention.
According to statistics, the patients who are under constant supervision of a specialist and comply with all regulations easier to tolerate the operation. And the rehabilitation period comes less painful.
In rare cases left after the surgery side effects. Young people sometimes after surgery may appear new lesions on the palm, in this case, you will need another surgery.
Usually the disease «returns» in a few years or decades.
The main goal is to remove the affected area. The Palmar fascia is partially (fully) subjected to excision. After the operation you can observe positive dynamics, restoration of mobility of the fingers of the hand in full.
This complex operation, which is performed to correct the contracture. This radical method of treatment technique which is difficult enough. The operation conducted by the surgeon of the highest category.
It is necessary to consider all the complications that may arise during the operation. The precision will determine the problem and find the optimal solution in a critical situation.
The principle of aponeurotomy: remove affected tissue, while not damaging the nerve endings of the wrist, and blood supply of the fingers.
After plastic surgery
To give the skin the original form, it is necessary to remove all defects that appear during the operation:
- to avoid pathologies and not to disrupt the blood supply on the skin;
- it is necessary to carry out prevention of the appearance of hematomas;
- effectively closes the wound.
You must select the anesthetic, which is used for the operation (local or General anesthesia).
Then handle the hand, which is usually used enzyme preparations. This is necessary so that during operation it was possible to easily divide the scar tissue that is underneath the skin.
If you correctly prepare for the surgery, the skin areas not exposed to strong excision.
But successful surgery does not guarantee complete recovery required a full range of treatments.
To achieve a positive result, it is necessary to hold:
- preoperative preparation;
- and the recovery period after surgery.
What is included in rehabilitation?
After surgery, the patient must undergo a complex recovery procedures:
- visiting the physical office;
It is necessary for motor function recovery. Rehabilitation must ensure full quality of life.