Dupuytren’s Contracture - Physiotherapy- Home Management and Exercises - Part 3

Usually exercises to the hand will not prevent or slow down the progress of Dupuytran's Contracture. But they may be helpful if one has a mild or early form of the disease. Hand exercises are very important after surgery. It is very important that before resorting to an exercise program, a consultation with a physiotherapist may be sought. Usually these exercises aim at stretching and strengthening the muscles, tendons and joint capsules of the hand and fingers. In this article I would like to explain few hand exercises that may be useful as home exercises. For more exercises please refer my earlier articles on Carpal Tunnel Syndrome.

Let the patient has right Dupuytran's Contracure.
Starting Position- The patient sits on a chair near a table facing it. The patient places his bend right elbow, right forearm and right hand on the table in such a way that the front side (flexor aspect) of the right forearm and the palmar aspect of the right hand lie flat on the table with the fingers extended.
Exercise- The patient extends the right wrist (lifts up the right hand), with the fingers extended, to the maximum. Now hold the extended right little finger with the left hand. Slowly and gently pull the extended right little finger backward in such a way that the extension of the little finger occurs at the 5^th metacarpo phalangeal joint, the right wrist still held in extension. While the right little finger is held in extension, flex (bend) all other fingers forward in such a way that the flexion (bending) occur at their respective metacarpo phalangeal joints so that a maximum stretch is felt along the contracted slip of the palmar fascia to the right little finger. Stretching must be done with in the limits of severe pain. Hold in this stretched position for 3 seconds. Slowly and gently return back to the starting position. Repeat the exercise with the other fingers also, in the order from the ring finger to the thumb. This exercise cycle is repeated 5 times. Now try the same exercise in the reverse order, first with the thumb and last with the little finger.

Let the patient has right Dupuytran's Contracture.

Starting Position- The patient stands near a table facing it. He keeps his right hand on the table with the elbow and wrist extended (straight) in such a way that the palmar aspect of the right hand lies flat on the table with the fingers extended (straight).

Exercise-1-Hold the right little finger with the left hand and slowly and gently pull the extended right little finger backward in such a way that the extension of the right little finger occurs at the 5^th metacarpo phalangeal joint, the palm of the hand and other fingers still lie flat on the table. The backward pull on the right little finger is continued till a maximum stretch is felt along the contracted slip of the palmar fascia to the right little finger. Stretching must be done within the limits of severe pain. Hold in this stretched position for 3 seconds. Slowly and gently return back to the starting position. Repeat the exercise with the other fingers also, in the order first with the ring finger and last with the thumb. This exercise cycle is repeated 5 times. Now try the same exercise in the reverse order, first with the thumb and last with the little finger.
Exercise -2 -Hold all the right fingers with the left hand in such a way that the palmar aspect of the left hand lies on the palmar aspect of the right fingers and the palmar aspect of the left thumb lies on the dorsal aspect of the right fingers. Now pull the right fingers backward (in such a way that the backward movement occurs at the metacarpo phalangeal joints) with the left hand slowly and gently with the right fingers held straight. The backward pull is continued till a maxi mum stretch is felt along the contracted slips of the palmar fascia to the fingers. Hold in the maximum stretched position for 3 seconds. Return back to the starting position.

Let the patient has right Dupuytran's Contracture.
Starting Position- The patient stands near a table facing it. He keeps his right hand on the table with the elbow and wrist extended (straight) in such a way that the palmar aspects of all the fingers (except thumb) lie flat on the table with the fingers extended (straight) so that the metacarpo phalangeal joints of all fingers (except thumb) correspond to the edge of the table and the palm of the hand out side the table.

Exercise-Now lift the palm of the right hand up with the fingers maintaining the same position. Upward movement of the palm of the right hand is continued till a maximum stretch is felt in the contracted palmar fascia. Stretching must be done within the limits of severe pain. Hold in the maximum stretched position for 3 seconds. Slowly and gently return back to the starting position.

.Let the patient has Dupuytran's Contracture.
Starting Position- The patient sits on a chair near a table facing it. The patient keeps his bend both elbows on the table a foot apart in such a way that both elbows are flexed (bend) approximately to 45 degrees with the forearms and the palmar aspects of both the hands facing each other with the fingers extended.
Exercise- The palmar aspects of both hands are brought closer to each other and they are held in contact with each other in such a way that the palms and the palmar aspects of the fingers of both hands are in contact with each other. The left hand pushes the right hand outwards (the right wrist extends). Pushing is continued till a maximum stretch is felt in the contracted palmar fascia (stretch may also be felt along the length of the contracted slips of the palmar fascia leading to the fingers). Hold in the maximum stretched posotion for 5 seconds. Slowly and gently return back to the starting position. Repeat the exercise 5 times.

Let the patient has right Dupuytran's Contracture.

The patient ts on a chair near a table facing it. He keeps his bend right elbow on the table in such a way that the right elbow is flexed approximately to 45 degrees with the forearm and the palmar aspect of the right hand facing upwards with the fingers extended. Now the patient holds his right hand with his left hand in such a way that the fingers of the left hand lies on the dorsal aspect of the palm of the right hand and the left thumb lies on the palmar aspect of the palm of the right hand. With the hold on, the left thumb massages the contracted palmar fascia at the middle of the palm and then along the length of the contracted slips of palmar fascia to the affected fingers. Massage is done by moving the thumb in the clockwise direction and then in the anticlockwise direction.

Avoid activities that demand continuous and strenous activities.

Let the patient has right Dupuytran's Contracture.
This exercise can be done while sitting, standing or lying. Hold a rolled up towel in the right hand. Grasp it as firmly as possible and squeeze it tightly. Hold the squeeze for 5 seconds. Slowly and gently release the grip and relax. Repeat the exercise 10 times.

Let the patient has right Dupuytran's Contracture.
Pick up objects with the right hand. Start with large objects, which will be easier to do. Now the exercise may be progressed to picking up smaller objects

Let the patient has right Dupuytran's Contracture.
Starting Position- The patient sits on a chair near a table facing it. He keeps his both bend elbows on the table a foot apart, in such a way that both the elbows are flexed (bend) approximately to 45 degrees with the forearms and the palmar aspects of both hands facing each other with the fingers extended.

Exercise- Bend the fingers of both the hands in such a way that the tips of fingers of the right hand touch the tips of the corresponding fingers of the left hand. Pressure is applied against each other ie. The left hand tries to push the right hand and fingers towards right whereas the right hand tries to push the left hand and fingers towards left. Hold the pressure for 5 seconds. Now slowly and gently return back to the starting position. In short, equal and opposite pressure is applied against each other. Hence no movement occurs. But the flexor muscles of both arms, wrists and fingers contract isometrically. Repeat the exercise 10 times.

Let the patient has right Dupuytran's Contracture.
Starting Position- The patient sits on a chair near a table facing it. He keeps his bend right elbow on the table in such a way that the right elbow is flexed (bend) approximately to 45 degrees with the forearm and the palmar aspect of the right arm facing upwards.

Exercise- Touch the tip of the thumb to the tip of the little finger and then to the tips of other fingers one by one, first to the little finger and last to the index finger. The same exercise may be done in the reverse direction ie. Touch the tip of the thumb to the tip of the index finger and then to the tips of other fingers one by one, first to the index finger and last to the little finger. After touching to the tip of each finger, the thumb must be brought back to the starting position.

Let the patient has right Dupuytran's Contracture.
Starting Position-Same as above.
Exercise- Touch the tip of the right thumb to the second phalanx of the little finger and then to the second phalanges of other fingers one by one, first to the little finger and last to the index finger. Same exercise may be done in the reverse direction ie. Touch the tip of the right thumb to the second phalanx of the index finger and then to the second phalanges of other fingers one by one, first to the index finger and last to the little finger. After touching the second phalanx of each finger, the thumb may be brought back to the starting position.

Let the patient has right Dupuytran's Contracture.

Starting Position- Same as above.
Exercise- Hold the right hand in such a way that all the fingers, except the thumb, are held closer to each other. Now spread out the thumb away from the rest of the fingers. Now bend thumb and bring back it and touch the base of the little finger. After touching the base of the little finger, the thumb may be brought back to the starting position.

I hope this article was useful for you all. If you have any questions, feel free to post them below or contact me on

Facebook

Twitter