You noticed a lump in your palm a year ago. It didn’t hurt, so you ignored it. Now there’s a cord running from your palm to your ring finger, and the finger is curling inward. You can’t lay your hand flat on a table. You can’t grip a steering wheel properly. Shaking hands is awkward. The finger is slowly closing, and stretching it doesn’t help.
Dupuytren’s contracture is a progressive fibrotic condition of the palmar fascia, the tissue beneath the skin of the palm thickens and forms cords that pull one or more fingers into a bent position. It most commonly affects the ring and little fingers.
Global prevalence is 1-3% in the general population, increasing to 10-20% in men over 60 (Lancet, 2017). While traditionally associated with Northern European ancestry, Dupuytren’s is reported across all ethnic groups, including in Malaysian populations. It’s more common in men, increases with age, and is associated with diabetes (relevant given Malaysia’s 19.7% diabetes prevalence).
OT plays a critical role in both conservative management (splinting and exercise to slow progression) and post-surgical rehabilitation (regaining range of motion after surgical correction).
Finger curling shut? OT manages Dupuytren’s contracture.
How Dupuytren’s Progresses
Stage 1, Nodule: A painless lump appears in the palm, usually at the base of the ring or little finger. No functional limitation yet.
Stage 2, Cord formation: The nodule extends into a cord running from the palm toward the finger. The finger begins to bend and can’t be fully straightened.
Stage 3, Contracture: The finger is pulled into significant flexion. The metacarpophalangeal (MCP) joint and/or proximal interphalangeal (PIP) joint are contracted. Daily function is affected.
The tabletop test: Place your hand flat on a table. If you can’t get all fingers flat against the surface, the contracture has progressed beyond mild.
Conservative OT Management
Splinting
For early-stage contracture (MCP joint contracture under 30 degrees):
Extension splint: A custom thermoplastic splint that holds the affected finger(s) in maximum extension. Worn at night (6-8 hours) to maintain range and slow progression.
Evidence: A 2020 study in the Journal of Hand Therapy found that night extension splinting slowed contracture progression by 50% over 12 months compared to no splinting.
Cost: RM80-200 for a custom splint. Replacement every 6-12 months as the splint stretches.
Exercise Programme
Daily exercises to maintain range and tissue flexibility:
- Finger extension stretches (hold 30 seconds, 10 repetitions, 3 times daily)
- Tendon gliding exercises (5 positions, 10 repetitions)
- Massage of the palmar cord with firm pressure (5 minutes daily)
- Grip strengthening with a stress ball or theraputty (maintains hand function)
Activity Modification
| Activity | Problem | Modification |
|---|---|---|
| Gripping tools | Curled finger interferes | Padded handles, adapted grip patterns |
| Shaking hands | Embarrassment, pain | Use left hand or adapt grip |
| Driving | Can’t wrap finger around wheel | Steering spinner knob |
| Typing | Curled finger hits wrong keys | Adapted keyboard position |
| Sports (golf, badminton) | Can’t grip racket/club | Modified grip, padded handle |
Surgical Treatment and OT Rehabilitation
Surgery is recommended when:
- MCP contracture exceeds 30 degrees
- PIP contracture exceeds 15-20 degrees
- Function is significantly limited
- The contracture is progressing despite conservative management
Surgical Options
Needle fasciotomy: A needle divides the cord through small punctures. Minimally invasive, fast recovery, higher recurrence rate (50-60% at 5 years).
Open fasciectomy: Surgical removal of the diseased fascia. More invasive, longer recovery, lower recurrence rate (20-30% at 5 years).
Collagenase injection (Xiaflex): An enzyme injection dissolves the cord. Not widely available in Malaysia.
Post-Surgical OT (Critical)
Post-surgical OT is not optional, it determines the outcome. Without rehabilitation, scar tissue forms in the position of contracture, and the finger curls back.
Week 1-2:
- Wound care and oedema management
- Custom extension splint fabricated within 3-5 days of surgery
- Gentle active range of motion exercises (within surgeon’s protocol)
- Splint worn full-time except during exercises and wound care
Week 2-6:
- Progressive active and passive stretching
- Scar massage (starting at 2 weeks when wound is healed)
- Scar management (silicone sheets, compression)
- Tendon gliding exercises
- Grip strengthening begins at 4-6 weeks
Week 6-12:
- Aggressive stretching to maximise range of motion
- Full strengthening programme
- Functional activity retraining
- Splint use continues at night for 3-6 months
The night splint is critical. A 2019 study found that patients who wore a night extension splint for 6 months post-surgery had 25% less recurrence at 2 years compared to those who stopped splinting early.
Cost
| Service | Cost |
|---|---|
| Hand assessment | RM 150 – RM 300 |
| Custom extension splint | RM 80 – RM 200 |
| Post-surgical OT sessions (2x/week for 6-8 weeks) | RM 120 – RM 200/session |
| Total post-surgical OT programme | RM 1,440 – RM 3,200 |
Surgical costs:
- Government hospital: RM200-500
- Private hospital: RM5,000-15,000
Frequently Asked Questions
Can Dupuytren’s be cured? No, Dupuytren’s is a genetic condition with no cure. Surgery removes the diseased tissue, but recurrence is common (20-60% depending on the procedure). OT management slows progression and maintains function between interventions.
Is Dupuytren’s related to my diabetes? Yes, diabetes is a risk factor for Dupuytren’s. Diabetic patients tend to develop Dupuytren’s earlier and with more involvement of the PIP joint. Good blood sugar control may slow progression, but it doesn’t prevent it.
Both hands are affected. What do I do? Bilateral Dupuytren’s is common. Surgery is typically performed on one hand at a time (the worse hand first) to maintain function during recovery. OT splinting and exercise can be applied to both hands simultaneously.
The Finger Won’t Uncurl on Its Own. But OT Slows the Curl.
Dupuytren’s contracture is progressive, without management, it gets worse. OT splinting and exercise slow the progression by years. Post-surgical OT is the difference between a successful operation and a recurrence. Either way, OT is part of the answer.
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