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Hand Splints for Dupuytren Contracture After Surgery: Yes or No?
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Posted on: 08/13/2013
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In this investigation, hand therapists from New Zealand study the effect of hand splinting at night (night extension orthoses) after surgery to release Dupuytren contracture. They asked the questions: are these splints helping? Does everyone need to be splinted after surgery? Is it possible the splints actually delay the return of finger motion, strength, and function?
Dupuytren contracture is a fairly common disorder of the fingers. In this condition, the fascia (connective tissue) of the hand is transformed into shortened cords. The patient first notices a thick nodule (knob) or a short cord in the palm of the hand, just below the ring finger.
More nodules form, and the tissues thicken and shorten until the finger cannot be fully straightened. This contracture is like extra scar tissue just under the skin. As the disorder progresses, the bending of the finger becomes more and more severe, which limits the motion of the finger. Dupuytren's contracture usually affects only the ring and little finger. The contracture spreads to the joints of the finger, which can become permanently immobilized.
Without treatment, the contracture can become so severe that the affected finger(s) cannot be straightened. Eventually loss of motion leads to loss of hand function, including grip strength. Because our fingers are slightly bent when our hand is relaxed, many people put up with the contracture for a long time. Patients with this condition usually seek medical advice for cosmetic reasons or the loss of use of their hand. The condition usually isn't painful, but the nodules can be sensitive to touch.
Surgery is often required when the contractures are severe. Removal of the palmar fascia (palmar fasciectomy) or release of the diseased cords is a common way to treat advanced Dupuytren contracture. Bracing and stretching of the fingers alone has not been proven to help in the long term progression of this condition. And now, according to the results of this study, night splinting after surgery may not be any more effective than not splinting.
The hand therapists randomly divided patients with Dupuytren contracture who had surgical release into two groups. The patients in one group received a custom-made night extension orthosis along with hand therapy. The second group just had hand therapy (no splint).
Both groups were treated for three months. Results were measured and compared for the two groups using finger extension, finger flexion, grip strength, and hand function as the final outcomes. Motion measurements were taken of each individual finger joint and for total combined finger motion (referred to as total active extension and composite flexion). Measurements were taken before surgery, at the first visit with the hand therapist after surgery, six weeks after surgery, and one last time three months after surgery.
They found out that splinting did not improve results following surgical release for this condition. The practice of routinely holding fingers in an extended position at night did not prevent loss of motion -- at least not after three months' time. Contracture recurrence is common (more than half of all patients experience this problem) and wearing a night splint doesn't seem to help.
It's possible that wearing the splints for a longer period of time may be helpful. Perhaps the use of night positioning during the formation of new scar tissue requires longer time to change tissue length. It is also possible that the type of splint makes a difference. A different design may provide more optimal joint motion. Since there are three joints in each finger, it is possible that the joints respond differently from one another in the type of splinting used in this study.
And since not all patients developed recurring contractures, there may be other factors at play here. Further research is needed to determine predictive factors (who is most likely to develop contractures again) that can be used to identify patients who should be splinted after surgery (and for how long).
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References:
Julie Collis, MSc (Hons) et al. The Effect of Night Extension Orthoses Following Surgical Release of Dupuytren Contracture: A Single-Center, Randomized, Controlled Trial. In The Journal of Hand Surgery. July 2013. Vol. 38A. No. 7. Pp. 1285-1294.
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