Dupuytren’s Contracture -Physiotherapy Management- Home Management and Exercises - Part 2
Introduction
Usually physiotherapy may not prevent Dupuytren’s Contracture or slow down its progress. However, physiotherapy is found to be beneficial if done in the early stage itself when the disease is of mild form. But advanced and severe cases need surgical interference and correction. Anyway, intense post operative physiotherapy for the hand is recommended by the surgeons. The exercise program must be charted out in consultation with a physiotherapist because the post operative requirements vary from patient to patient. Usually, these exercises aim at stretching and strengthening the muscles and tendons of the hand and fingers. In this article I deal with different physiotherapy modalities and exercises that are suitable for a patient with Dupuytren’s Contracture, before and after surgery.
Post Surgical Care
After surgery the finger or the fingers are put up in extension (straight) by means of a splint applied to the palm of the hand extending to the operated finger or fingers. The period or time for which the splint is to be worn depends on the views of the surgeon. Usually the day time splint is discontinued as early as possible(1-2 weeks). This is done to avoid stiffness of the hand and fingers. Now simple and well guided passive and active movements are encouraged. The rigid splint may be substituted by a flexible splint. A night splint may be used for some months after surgery.
1. Wax Bath
Wax Bath is very useful in treating Dupuytren’s contracture before and after surgery. Paraffin Wax for therapy is one of the most convenient and efficient methods of applying conducted heat to the hand. Paraffin Wax with low melting point, 55 degree celsius, is used. In order to keep the melting point of liquid Paraffin Wax to low temperatures (to prevent burns), liquid paraffin mineral oil is added to the melted paraffin wax.The Paraffin Wax then gets melted at a temperature of 40-44 degree celsius, and hence cause no burns. The Paraffin Wax has a low thermal conductivity and hence it gives off heat very slowly. The hand is dipped in the melted wax (40-44 degree celsius) and the wax is allowed to set around the immersed hand. The hand is dipped 7 times so that 7 layers of wax will be set around the immersed hand. Because of the lower thermal conductivity of the wax the patient will feel less heat when compared to hot water of the same temperature. There will be no rapid loss of heat from the treated hand as the wax is self insulating. Moreover the first layer of wax creates a thin layer of air next to the skin as there is no absolute contact between the skin and the first layer of wax, which also acts as an insulator. Remove the wax from the hand when the heat subsides. After the removal of the wax the hand cools quickly.
How Wax Bath helps?
a. Analgesic Effect- Sedative and Soothing Effect. Hence used prior to manipulations and exercises.
b. Stretching Effect- It makes the skin moist, soft and pliable. Hence preferably used prior to manipulations and exercises.
c. Relieves muscle spasm.
d. Reduces oedema.
e. Subsides inflammation.
2.Contrast Bath
Contrast Bath is an alternative method of applying heat with certain amount of control to aid the normal body temperature regulating mechanism. In Contrast Bath, the treatment involves the immersion of hand in the hot and cold water alternately. Care must be taken that the hot and cold water must be maintained at the constant temperature throughout the exercise program. Two baths of suitable, one with hot water at 40 degree celsius- 44 degree celsius and the other with cold water at 15 degree celsius are taken. The treatment should begin and end with hot water. Some prefer the treatment to end with cold water. Immerse the hand in the hot water and hold it immersed for 3 minutes. Do active movements of wrist and small joints of hand and fingers while dipped in hot water. Immediately after wards immerse the hand in the cold water and hold it immersed for 3 minutes. Do active movements of wrist and small joints of hand and fingers while dipped in cold water. Repeat the cycle up to 5 times.
How Contrast Bath helps?
a. Analgesic Effect- Sedative and Soothing Effect. Hence used prior to manipulations and exercises.
b. Stretching Effect- It makes the skin soft, moist and pliable. Hence preferably used prior to manipulations and exercises.
c. Relieves muscle spasm.
d. Reduces oedema.
e. Subsides inflammation.
3. Ultra Sound Therapy
Ultra Sound Therapy is an unique form of treatment commonly used in physiotherapy. It is unique because in Ultra Sound Therapy, longitudinal waves of sound are used for treatment purpose. Ultra Sound causes the compression and rarefaction of a vibrating media. It is the utilization of sound energy for the treatment of human tissues. The sound energy is supplied through a transducer head which consists of a crystal mounted at the front. The energy is applied to the part to be treated through the transducer through a coupling medium viz. Liquid paraffin, ultra sound gel, olive oil etc. The crystal vibrates and therefore when in contact with the tissues it provides a form of micro- massage. Massage, which has been used in the treatment of soft tissues in the earlier days, is now brought up to date by the Ultra Sound Energy. This enables treatment to be given to deeper tissues because of its penetrating nature. As the Ultra Sound penetrates in to deeper tissues, it produces the effects of heat in the deeper tissues because of its micro- massage effect. Ultra Sound is highly helpful to treat acute injury areas where pressure cannot be applied due to pain and also to the chronic injuries.
How Ultra Sound Therapy helps?
a. Analgesic Effect- Sedative Effect and Soothing Effect. Hence used prior to manipulations and exercises. If pain is due to the accumulation of metabolites causing ischaemia and swelling in the region, Ultra Sound alters the permeability of the cell membrane and aids in accelerating the process of absorption of exudate. Ultra Sound causes capillary hyperaemia resulting in the release of histamine-like substance which are produced by the thermal effects of Ultra Sound. This also helps in removing the pain metabolites.
b. Stretching Effect- It makes the skin soft, moist and pliable. Hence used prior to manipulations and exercises.
c. Relieves muscle spasm.
d. Reduces oedema.
e. Subsides inflammation.
f. Softens and reabsorbs adhesions – Softening and reabsorbing of adhesions is brought about by the heating and micro-massage affect of Ultra Sound. The quick rise in temperature which lasts longer, its ability to penetrate and its micro-massage effect help in this process absorption.
g. Increases the extensibility of the tendons- Sclerolytic action of Ultra Sound increases the extensibility of the tendons, which are shortened by the strain, inflammation and disease.
