'Dupuytren's disease (DD) is a very common condition of the hand for which most people do not seek treatment. There is a broad spectrum of involvement: from slight thickening of the palmar fascia, which may not be noticed by the individual, to widespread disease of the palmar fascia and the digital fascia associated with severe digital joint contractures. Dupuytren's disease has been called a disease of the Celtic race. It is very common and often severe in people of Northern European origin, but it is not uncommon in most races'. Robert McFarlane
As most people do not seek treatment in the desirable time frame to operate to remove the diseased tissue, the intrinsic muscles of the hand tighten and shorten as the finger is pulled into the palm of the hand by the disease for prolonged periods of time. When the patient finds it too difficult to perform simple tasks such as putting their hand in their pocket or shaking someone's hand, they decide to have a Dupuytren's Fasciectomy. By this time adaptive shortening of the intrinsic muscles and contracture of the ligaments that support the PIP joint becomes severe. Once the patient has had surgery to release the contracture and extension of the MCP, PIP and often the DIP joints is regained, the patient begins the difficult journey of hand rehabilitation to regain digital flexion. Often, the imablity to regain digital flexion becomes more disabling than the original condition. Howw do therapists rehabilitate the stiff hand following Dupuytren's Fasciecomy? The apply an orthosis to maintain digital extension and begin to passively mobilize the fingers into flexion. They attempt to reduce the edema with coban wrapping and other therapeutic techniques and begin functional retraining.
Often the journey to full function involves multiple hand therapy appointments at great expense, but a satisfactory result is not guaranteed. This case study will demonstrate a few aspects of this journey:
1. The patients perspective
2. Why traditional therapy fails
3. The use of the CMMS technique
The following images show the patient's status 2 weeks post op.
Follow Ian's rehabilitation journey.
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