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Could You Give Me A Hand ?

Could You Give Me A Hand?

Amy Savarese, DPT, MOT, OTR/L

       You are 40 years old and your life is so fabulous that even Bill Gates would be jealous. Not only do you have the entire world in your hands, but a small nodule in the palm of your hand has recently appeared to join in on the fun! You pay it little attention because it’s not painful and is not much of a nuisance.  Fast forward a few years and you may find that small asymptomatic nodule has developed into a monster of an issue, which may be disabling.  What seemed at one time to be so minute now is causing a severe hand deformity as well as resulting in the inability to place your hand in your pockets, use utensils or tools, grasp a steering wheel, turn door knobs, shake hands, golf, fish, shoot pool, wear gloves, or even hold a glass of water.

        Your physician may diagnose you with a unilateral or bilateral Dupuytren’s contracture. Pronounced, doo-pa-trens, it is a chronic progressive condition that specifically affects the layers of connective tissue beneath the skin of the palm known as, fascia. Fascia is not specific to the hand; it spans the entire body encasing muscle, nerves and blood vessels with the sole purpose of reducing friction between structures as the body moves. The palmar fascia of the hand is arranged longitudinally from the palm to the fingers and looks similar to fine pieces of thread. With Dupuytren’s, the fascia tightens creating knots and ultimately, cords of tissue causing the fingers to bend. Eventually, the condition progresses to a permanent flexion contractures of the hand causing disability. Since Dupuytren’s is a chronic progressive condition, it is often treated surgically in its later stages. Occupational or Physical Therapy follow for the purpose of wound management as well as assisting the patient in restoring pain-free range of motion and function.

         Fortunately only 3% of Americans are affected with a Dupuytren’s contracture but for them it is a troubling disorder.  Males are six times more likely to be affected than females.  It affects those who are typically older, Caucasian and of northern European descent. Although a primary etiological factor has yet to be determined, it has been discovered that the biochemistry of the tissues in the hand is abnormal and a genetic predisposition may exist.

          Although Dupuytren’s is a rare condition that causes severe deformities of the hand resulting in dysfunction and disability, it is important to note that any hand impairment should be addressed if you are experiencing difficulty performing everyday tasks (Activities of Daily Living) or any meaningful and purposeful occupation. Hands are a vital part of our bodies that are often underappreciated.  We often take their abilities and usefulness for granted until we encounter an issue impeding their function.  If you are such a person, have been diagnosed with arthritis, have a “clicking” finger (trigger finger) or any type of hand injury, your occupational therapist may be able to give you a “hand”. 

      Amy Savarese is a full-time Occupational and Physical therapist at First Coast Rehabilitation.  She has experience in hand therapy as well as providing therapy for patients with a variety of orthopaedic and neurological impairments