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Getting a hand back in the game

A hand with ring and pinky fingers taped and braced together.

Posted on 12/15/2020

Recently while watching a NFL football game, I came across a commercial with former professional football player John Elway. Mr. Elway was talking about a hand issue he was having called Dupuytren’s contracture, and he explained that there is now a non-surgical treatment option for this condition.

As a certified hand therapist for almost 17 years now, I am very familiar with Dupuytren’s contracture. However, to see this hand issue brought to life via a TV commercial definitely caught my attention as it isn’t often discussed. In the commercial, Mr. Elway talks about having difficulty with common, everyday tasks and shows a picture of the contraction in the palm of his hand.

So, you may ask, “What is this condition?”

Imagine having a finger, or fingers, bent into the palm and being unable to open the hand up fully. This would affect your ability to lay your hand flat on a tabletop, place your hand into a glove or shake hands. In the case of Mr. Elway, he could not grip or throw a football correctly, an activity that he had done for 16 years as a football player. It even affected his golf game.

There is no known cause of how Dupuytren’s develops. It has been thought of as a condition that people who have origins in northern European countries can contract. It is often called “The Viking’s Disease.” It is most commonly found in men of 50-60 years of age, but women can also be impacted. It affects three percent of the U.S. population.

Dupuytren's symptoms can take a long time to develop. Mr. Elway mentions in the commercial that he was diagnosed 15 year ago. Signs of Dupuytren’s includes:

  • A hard lump in your palm
  • Inability to place your hand flat on a surface such as a tabletop or counter
  • Scar-like bands that form in the palm
  • Fingers bent into the palm with the inability to open/extend your finger fully
  • Hand pain (although this is less common)

Our hands contain a tough, fibrous layer of tissue called palmar fascia which gives us a protective layer between our skin and tendons. It also gives our palms firmness. In Dupuytren’s, the fascia can thicken and contract. The most common, visible sign of Dupuytren’s are the hard lumps and bands which are known as nodules and cords. The combination of nodules, cords and the contracting palmar fascia can make your fingers bend in toward your palm.

I often see patients with Dupuytren’s contracture after they have had some sort of procedure or surgery done to their hand. Many have come to me after they have been diagnosed and treated by a hand surgeon. There are two popular techniques to manage Dupuytren’s contracture, as there is no cure:

  • Surgery, where a hand surgeon opens up the skin and removes all the excess tissue. 
  • An injection to the fibrous cords, which will break them down.

Typically after either surgery or the injection, therapy by a certified hand therapist is indicated. There are many ways that a certified hand therapist can help patients with Dupuytren’s contracture.

Therapy after surgery or injection would first consist of an extension orthosis, commonly known as a splint. An orthosis is custom-made for each patient using a piece of thermoplastic material and Velcro strapping. This would help the finger or fingers stay straight. A patient can wear this full-time or just at night, depending on what their surgeon indicates.

Range of motion exercises are given to help regain full mobility of the hand and fingers. A patient’s wound would be addressed if they have had surgery to watch for infection and manage scar tissue. Lastly, a patient’s strength would be addressed. The end goal for our patients is that they will have functional capability of their hands and are able to perform all the activities of daily living that they choose to do in their lives.

Please contact your local outpatient center to schedule an appointment with a certified hand therapist to discuss the various options for Dupuytren’s contracture and determine if therapy may be beneficial for you.

By: Kelly Lee O’Connor, M.S., OTR/L, CHT. Kelly is an occupational therapist/certified hand therapist for NovaCare Rehabilitation in Horsham, PA. Images supplied by Linda Lamaute, M.S., OTR/L, CHT.

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