Physiotherapy plays a crucial role in the management of Dupuytren’s contracture, both in non-surgical cases (especially in early stages to slow progression) and, most importantly, post-surgical or post-injection rehabilitation to maximize recovery of hand function and prevent recurrence or adhesions.
- Manual Therapy
- Joint Mobilization: Gentle mobilization of the metacarpophalangeal (MCP) and interphalangeal (PIP/DIP) joints of the affected fingers and adjacent unaffected fingers is crucial to maintain or restore joint play and prevent stiffness. This is particularly important post-surgery to address any post-operative stiffness.
- Soft Tissue Mobilization: Direct massage and mobilization of the palmar fascia and surrounding soft tissues (muscles of the hand, forearm) can help to:
- Improve blood flow and tissue extensibility in the early, nodular phase.
- Reduce tenderness and discomfort.
- Address scar tissue and adhesions post-surgery.
- Tendon Gliding Exercises: Specific manual techniques and patient-led exercises designed to ensure the flexor tendons of the fingers glide smoothly within their sheaths. This is vital post-surgery to prevent tendon adhesions to the healing fascia.
- Myofascial Release (MFR)
- Application: MFR focuses on releasing restrictions within the fascial system. In Dupuytren’s, the problem is a fascial thickening and contraction. While MFR cannot dissolve the mature cords, it can be beneficial in:
- Early Stages: Addressing surrounding fascial tightness and improving overall hand and forearm flexibility.
- Post-Operative Care: Releasing fascial restrictions in the palm and fingers that may develop as part of the healing process or around the surgical site to prevent adhesions. It aims to restore the natural gliding planes of tissues.
- Technique: Sustained, gentle pressure and stretch applied to the involved fascia until a release is felt.
- Instrument-Assisted Soft Tissue Mobilization (IASTM)
- Application: IASTM uses specialized tools (e.g., Graston, Gua Sha) to detect and treat soft tissue restrictions, fibrosis, and scar tissue.
- Benefits:
- Early Stages: Can help to break down superficial fascial adhesions and improve tissue extensibility in the palm, potentially slowing progression or managing discomfort.
- Post-Operative: Highly effective for addressing scar tissue maturation and adhesions following fasciotomy or fasciectomy. It helps to remodel the scar tissue, improve its pliability, and prevent it from limiting movement.
- Technique: The tools are stroked over the affected area with varying pressure and direction.
- Active Release Technique (ART)
- Application: ART is a targeted soft tissue technique that addresses adhesions within muscles, tendons, ligaments, fascia, and nerves.
- Benefits: Can be particularly useful in addressing specific adhesions or restrictions in the hand and forearm muscles that may contribute to compensatory patterns or limit movement after surgery. For instance, addressing tight forearm flexors that might be contributing to stiffness.
- Technique: The therapist applies tension to the involved tissue while the patient actively moves the finger or hand through a specific range of motion.
- Muscle Energy Technique (MET)
- Application: MET uses gentle isometric contractions of the patient’s muscles to achieve therapeutic goals, such as increasing joint range of motion or releasing muscle tension.
- Benefits: Can be used to gently encourage extension in the affected fingers by engaging the finger extensor muscles, especially in the early stages or post-surgery once healing allows. It can also help to address any associated muscle imbalances in the forearm and hand.
- Technique: The patient performs a gentle isometric contraction against the therapist’s resistance, followed by a relaxation and a stretch into the new range of motion.
- Dry Needling
- Application: Dry needling targets myofascial trigger points within muscles that can cause pain, tenderness, or referred pain patterns in the hand and forearm.
- Benefits: While dry needling does not directly treat the Dupuytren’s cord, it can be used to alleviate associated muscle guarding, pain, and stiffness in the surrounding muscles (e.g., forearm flexors/extensors, intrinsic hand muscles) that might be compensating for the contracture or are tight due to the condition.
- Kinesiology Taping
- Application: Kinesiology taping can be used to:
- Provide Gentle Support: To the fingers in a more extended position, without rigid immobilization, encouraging gentle stretching.
- Reduce Swelling: Post-operatively, it can help to reduce edema and bruising.
- Improve Proprioception: By stimulating sensory receptors in the skin, it can enhance awareness of finger position and encourage desired movement patterns.
- Facilitate Muscle Activity: To support weak extensor muscles or inhibit overactive flexors, although this is more relevant in general hand rehabilitation rather than direct cord reversal.
- Technique: Applied with specific tension and direction by a trained therapist.
Rehabilitation for Dupuytren’s Contracture
A complete physiotherapy program, especially post-surgery or collagenase injection, will also include:
- Therapeutic Exercises:
- Range of Motion Exercises: Gentle active and passive stretching to regain full finger extension and flexion. These are the cornerstone of post-operative rehab.
- Strengthening Exercises: As healing progresses, strengthening exercises for the hand and forearm muscles are introduced to restore grip strength and fine motor skills.
- Tendon Gliding Exercises: Specific exercises to ensure smooth movement of tendons within their sheaths and prevent adhesions.
- Blocking Exercises: Isolating movement at specific finger joints.
- Scar Management: Techniques like silicone sheeting, massage (including IASTM), and desensitization to make the scar pliable and minimize hypersensitivity.
- Edema Control: Elevation, gentle compression, and retrograde massage to manage post-operative swelling.
- Functional Training: Gradually reintroducing and adapting activities of daily living to improve hand dexterity and independence.
