Palmar Fascia, also known as Dupuytren’s contracture, is a deformity of tissues under the skin of the palm in which joints of one or more fingers cannot fully be straightened. Ring and little fingers are usually the most affected, though some people experience this condition in other fingers as well.
According to a study, about 5 percent of people living in the United States suffer from Dupuytren’s Contracture; while this condition is declining worldwide, new cases have also emerged.
Some patients suffering from Dupuytren's disease report no pain or itching, whereas other studies show that these symptoms are more common in patients younger than 40yrs, which might indicate aggressive disease.
If you’re 24% of the patients that suffer from itching and pain with palmar fascia, there are different ways to relieve the pain and hopefully recover the range of motion.
But, to understand the effectiveness of the methods presented below, we will have to comprehend the pathology, causes, anatomy, and risks caused by the disease.
What is Dupuytren’s Contracture?
The palmar fascia is a triangular structure near the palm, an extension of a tendon from the arm called the palmaris longus tendon. It protects the flexor tendons, lumbricals, and neurovascular structures and separates these by thick fibrous bands.
In Dupuytren’s disease, The cords surrounding the palmar fascia grow into tight bands of tissue. The affected fingers are gradually drawn lower by these strands, curling toward the palm. The ability to stretch the affected fingers gets harder or impossible as the illness progresses.
Biology of Dupuytren’s Contracture
The biology works as follows: when a body part is injured (or believes it is being injured), it releases proteins called distress protein into the bloodstream, acting as a signal of emergency.
These proteins go throughout the body and finally reach the bone marrow, which causes the release of fibrocytes into the bloodstream.
The blood gets flooded with fibrocytes, leading to the injured area by the released proteins through blood vessels. They make their way out of the blood vessel and crawl into the tissues that have the damage.
They transform into myofibroblasts, cells that make collagen, and start pulling and toughening the tissues, generally causing Dupuytren contracture.
Things to Avoid If You're Suffering From Palmar Fascia Pain
Following are some things that you must avoid if you have palmar fascia
- Alcohol - The consumption of alcoholic beverages causes liver damage which can aggravate fibrotic activity in the body affecting palmar fascia.
- Tobacco - Smoking cigarettes has harmful effects on the musculoskeletal system. And as per research, tobacco can worsen the prognosis of several orthopedic disorders and surgical procedures.
- Excessive Stress on Hand - Exercises or chores that put your hands under additional strain or force when you have Dupuytren's may be painful and exacerbate existing damage. Avoid doing anything that makes you repeatedly squeeze or strain your fingers. When doing chores or cleaning, wearing cushioned gloves might be helpful.
- Sugary and Junk Food - According to a recent study, the immune system reacts similarly to high fat and high-calorie diets as to a bacterial infection. This causes inflammation that persists even after switching to a healthy diet for quite some time. These long-term changes may be involved in the development of arteriosclerosis and diabetes. Patients with Type 1 Diabetes have the highest prevalence of Dupuytren's Contracture.
- Epilepsy Medications - Many studies have found that people who use epilepsy medication are seen to have a higher risk of Dupuytren's disease. This is because of the stimulation of tissue growth factors promoted by these types of medication.
Pain Relief Tips for Dupuytren’s Contracture
There's no cure for Dupuytren's contracture; however, there are different techniques and medicines that might help relieve the symptoms of discomfort, itching, and pain.
Following are 8 tips that will help resolve most of your symptoms:
1. Magnesium Supplements
A magnesium supplement might be helpful to loosen a contracture, though more research is necessary. According to a study from the Dupuytren Foundation, a woman with Dupuytren's contracture who started taking a magnesium supplement noticed improvement in her condition.
Dupuytren contracture is linked with calcium, as the cells use dissolved calcium to contract. This is true of both muscle contraction and contracture brought on by Dupuytren. Magnesium might block the cells from pulling on the tissues by reducing the effects of calcium.
Beware that magnesium is a micronutrient and can be harmful to the body if taken too much of. It’s best to check your magnesium level and contact a nutritionist to decide on a reasonable dosage of magnesium supplements.
2. Hand protection
Utilizing hand protection is one technique to improve the comfort of living with Dupuytren's contracture.
When working or performing other manual tasks, wearing padded gloves can reduce pressure on your palms and relieve stress from nodules, grooves, or delicate skin and can reduce injuries by 60-70%.
You can use DMoose palm grips or weightlifting gloves to keep your hand safe while handling heavy objects. Palm grips will assist in holding a pressure washer or a lawn mower, while weightlifting gloves will help you carry grocery bags or water bottles more easily.
3. Needle Aponeurotomy
Needle Aponeurotomy is a procedure to alleviate contracture and pain caused by Dupuytren's disease. This needling procedure doesn't require an incision, unlike surgery.
Your hand is numbed, and a needle is inserted in your hand. The needle is used to break down the band of tissues around your palmar fascia. The patient feels no pain during this procedure though mild discomfort can be felt.
According to a study, needle aponeurotomy provided a successful correction to 5° or less contracture immediately around 98% of the time but it might vary depending upon the joint. The complication rate was low, but recurrences were frequent in younger patients.
This procedure can be repeated in case of a recurrence.
4. Radiation therapy
Radiation is mainly advised for people who have not yet developed contractures and helps prevent them. Low-energy X-rays are used in radiation therapy to soften the nodules on your palm by striking the tissue cords.
There is much anecdotal evidence that radiation therapy for Dupuytren disease reduces nodule itch, tenderness, and firmness, but there is still much to learn about this treatment.
Radiation therapy isn’t harmful to the body, but results aren’t always promising.
5. Physical Therapy
Physical therapy can also help you regain some range of motion and lessen your pain. These treatments could include:
Heat Therapy - Applying heat to the palms of the hand before massage or exercise can help loosen the tissues. It also improves blood flow and overall minimizes the pain and the itch.
Massage - Massage your palm and fingers with the unaffected hand. You could perhaps ask someone else to do it.
This is a fantastic Dupuytren disease pain treatment technique. Rub your entire hand using light pressure, including the areas where the tissue has thickened. If you'd like, you can also get a professional massage. But keep in mind to also include items like oils, lotions, and heat.
Stretching - Numerous stretches and exercises can slow or stop the progression of Dupuytren's contracture. They are helpful in the early stages, though. These consist of the following;
Finger lifts: Lift each finger one at a time while your palm is resting on a smooth surface. After each lift, pause for a few seconds before lowering the fingers.
Palm raises: Extend your arms and raise and lower only your palm towards your forearms using your unaffected hand.
Hand press: Place your hands in front of you as if praying, then squeeze your fingers and palms together.
These stretches help loosen the muscle and tendons, causing stiffness and increasing the range of motion.
6. Enzyme Injection
Your doctor may inject an enzyme into the tough cord in your palm to weaken it and make it easier to handle your hand later on in an effort to break the chord and straighten your fingers.
For this use, the FDA has authorized the collagenase Clostridium histolyticum (Xiaflex). Needling and enzyme injection.
As per research, the success rate after a single injection was 76.6%, meaning 76.6% didn’t have any recurrences of symptoms. Meanwhile, there were no recurrences after a complete session of 30-month and 60-month follow-ups. Skin tears were the only adverse side effect of the Enzyme injection.
While this method is safe, there are some other side effects of enzyme injections that you should be familiar with:
Bleeding, bruising, and pain at the injection site are the most frequent side effects.
Rarer but more severe adverse effects can include tendon damage, nerve damage, or an allergic reaction.
7. Steroid Injections
Strong anti-inflammatory drugs are included in steroid injections, which are administered into Dupuytren's nodule.
It is advised to begin steroid injections when the disease is still in an early stage. The injections function by lessening the thickness of the Palmar Fascia. To control the pain, periodic steroid injections may be required.
It's crucial to remember that steroid injections risk tendon rupture or skin atrophy at the injection site.
Surgery is one of the most popular therapies for patients with severe stages of Dupuytren's contracture. It may help ease some of the discomforts and give your hand some of its movement back.
During a simple operation, the thicker tissue that has formed on your palm will typically be removed.
In severe cases of Dupuytren's contracture, a more thorough operation may be required. This is especially true if you have already had various procedures done to treat your condition.
During this sort of surgery, it is likely that all of the damaged tissue and the skin around it will be removed from your palm. You may need a skin graft to cover the areas of your palm where the skin has been removed.
Excellent results were observed in 76.66%, good results in 20%, and fair results in 3.33% of the cases, according to a study done in 2010.
Post-operative care is a must to achieve higher rates of correction and to limit complications and recurrence.
1. What are the symptoms of Dupuytren’s?
In the palm of the hand, Dupuytren's is characterized by an accumulation of irregular tissue beneath the skin. Pits, bumps, and thick chords may make fingers unintentionally bend. Particularly the ring and pinky fingers. It might affect both hands or just one, both fingers, or even more than one finger.
Dupuytren's symptoms include the following:
- Stiff fingers, particularly in the morning
- Using your fingers may cause popping or clicking.
- The base of your fingers in the palm may be painful, sore, or bumped.
- Fingers progressively start curling and get stuck in a bent position.
2. What causes Dupuytren’s?
Although there is no known cause of Dupuytren's disease, those with a family history of the condition, those with diabetes, and those with a history of smoking or alcohol consumption are at a greater risk of developing it.
3. Why is it called Dupuytren’s?
Napoleon's physician, Guillaume Dupuytren (1777–1835), is regarded as the most illustrious French surgeon of the 19th century. He operated in Paris in 1831 on a hand that he later characterized as having bent fingers due to a disorder. Since then, the illness has been given his name.
4. I have bumps or chords in my hand, but I can still use my fingers. What should I do?
It's not always the case that tissue accumulation will cause your fingers to contract and get locked. A lump may not always need to be treated, and the condition may not always progress. The majority of Dupuytren's hand bumps are not painful but uncomfortable. If you feel bumps in your hand, then the best route of action will be to reach out to a doctor for more guidance.
The condition known as Dupuytren's contracture, which causes the tissue in your palm to stiffen, can be excruciatingly painful and restrict your hand's range of motion.
Treatments, while not required for everyone, can help stop or significantly decrease the growth of the ailment, give pain relief, and ease other types of discomfort.
Surgical and needling techniques, hand protection, and possibly magnesium supplements are among the available choices.
Discuss the most effective strategies to treat your symptoms with your primary care physician or other healthcare practitioners, as every Palmar Fascia is different.
- Medlineplus. (2019, April 1). Dupuytren contracture: MedlinePlus Genetics. Dupuytren Contracture: MedlinePlus Genetics. https://medlineplus.gov/genetics/condition/dupuytren-contracture
- Dupuyterns. (2016, March 12). Dupuytren Pain and Itching. Dupuytren Research Group. https://dupuytrens.org/dupuytren-pain-and-itching/#:~:text=Dupuytren%20disease%20can%20be%20very,hand%20conditions%20such%20as%20arthritis.
- Vargas, A., Chiapas-Gasca, K., Hernández-Díaz, C., J. Canoso, J., Ángel Saavedra, M., Eduardo Navarro-Zarza , J., Villasenor-Ovies, P., & A. Kalish, R. (2012). Clinical Anatomy of the Hand. Published. https://doi.org/https://doi.org/10.1016/j.reuma.2012.10.004
- Verjee, L. S., Verhoekx, J. S. N., Chan, J. K. K., Krausgruber, T., Nicolaidou, V., Izadi, D., Davidson, D., Feldmann, M., Midwood, K. S., & Nanchahal, J. (2013). Unraveling the signaling pathways promoting fibrosis in Dupuytren’s disease reveals TNF as a therapeutic target. Proceedings of the National Academy of Sciences, 110(10). https://doi.org/10.1073/pnas.1301100110
- Abate, M., Vanni, D., Pantalone, A., & Salini, V. (2013). Cigarette smoking and musculoskeletal disorders. Muscles, ligaments and tendons journal, 3(2), 63–69. https://doi.org/10.11138/mltj/2013.3.2.063
- University of Bonn. (2018, January 11). Fast food makes the immune system more aggressive in the long term: Study shows that even after a change to a healthy diet, the body's defenses remain hyperactive. ScienceDaily. Retrieved September 3, 2022 from www.sciencedaily.com/releases/2018/01/180111141637.htm
- Salari, N., Heydari, M., Hassanabadi, M., Kazeminia, M., Farshchian, N., Niaparast, M., Solaymaninasab, Y., Mohammadi, M., Shohaimi, S., & Daneshkhah, A. (2020). The worldwide prevalence of the Dupuytren disease: a comprehensive systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 15(1). https://doi.org/10.1186/s13018-020-01999-7
- Critchley, E. M., Vakil, S. D., Hayward, H. W., & Owen, V. M. (1976). Dupuytren's disease in epilepsy: result of prolonged administration of anticonvulsants. Journal of neurology, neurosurgery, and psychiatry, 39(5), 498–503. https://doi.org/10.1136/jnnp.39.5.498
- Dupuytrens. Dupuytren Cord Calcification | Dupuytren Research Group. Dupuytren Research Group. Retrieved September 3, 2022, from https://dupuytrens.org/dupuytren-cord-calcification/#:~:text=Calcium%20plays%20a%20complex%20role,the%20cause%20of%20Dupuytren%20disease.
- Dupuytrens. (2016, June 8). Magnesium and Dupuytren disease. Dupuytren Research Group. https://dupuytrens.org/magnesium-and-dupuytren-disease/
- Sorock, G. S., Lombardi, D. A., Peng, D. K., Hauser, R., Eisen, E. A., Herrick, R. F., & Mittleman, M. A. (2004). Glove use and the relative risk of acute hand injury: a case-crossover study. Journal of occupational and environmental hygiene, 1(3), 182–190. https://doi.org/10.1080/15459620490424500
- Pess, G. M., Pess, R. M., & Pess, R. A. (2012). Results of needle aponeurotomy for Dupuytren contracture in over 1,000 fingers. The Journal of hand surgery, 37(4), 651–656. https://doi.org/10.1016/j.jhsa.2012.01.029
- Malafa, M. M., Lehrman, C., Criley, J. W., & Amirlak, B. (2016). Collagenase Dupuytren Contracture: Achieving Single Treatment Success with a Hand Therapist-Based Protocol. Plastic and reconstructive surgery. Global open, 4(2), e629. https://doi.org/10.1097/GOX.0000000000000565
- Khan, P. S., Iqbal, S., Zaroo, I., & Hayat, H. (2010). Surgical Treatment of Dupuytren's Contracture; Results and Complications of Surgery: Our Experience. Journal of hand and microsurgery, 2(2), 62–66. https://doi.org/10.1007/s12593-010-0019-2