44 April 2
Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.
Tel: (203) 637-7720
Luke, a seventy-two-year-old man who was born in Norway, reported that about a year ago he noticed a small lump growing along the fourth finger of his right hand that continued to the area where his palm and fourth finger meet. In the beginning, his finger felt only slightly tender; but six months later, the finger had gradually contracted and he experienced difficulty extending the finger at the metacarpal phalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) finger joints. Though he did not experience much pain, he did notice there was a cord of tissue under the skin of his palm that prevented him from extending his fourth finger and greatly interfered with his hand function and movement. This situation continued to develop over a year, at which point he went to his primary care physician who did not understand what was wrong with Luke’s hand. Luke was then referred to me.
In examining Luke’s hand, I found the cordlike tissue that had formed along his fourth finger and caused it to bend unnaturally towards his palm. There did not seem to be much tenderness in the area, but Luke had difficulty extending his fourth finger and coordinating it with his other fingers. He had tried massage, ultrasound, and physical therapy, including stretching exercises for the hand, but none of it helped and his symptoms were gradually getting worse, leading me to believe he had a condition known as Dupuytren’s contracture.
Symptoms, Causes, and Diagnosis
Dupuytren’s contracture is a very specific condition. It often affects people of Scandinavian or Northern European descent and has been called the Viking Disease, though it has also been found in Spain and the Far East.
Its primary characteristics include the following.
- People who are older than forty are the ones most likely to develop the condition. For anyone older than forty, the disease is more common in men than in women. By age eighty, however, gender is not an important factor.
- It is often a condition that is passed down through families.
- It usually happens in the fourth and fifth fingers; the thumb and index fingers are almost always spared.
- Some may contract Dupuytren’s after developing certain conditions, such as alcoholism, diabetes, epilepsy, liver disease or trauma.
Although Dupuytren’s contracture is poorly understood, many physicians and research scientists think it is caused by fibroblast proliferation and collagen deposits.
It is thought there are three stages of Dupuytren’s contracture.
1. The proliferation stage, which is characterized by the development of nodules. Many of the nodules may be located or felt at the far end of the palm’s crease.
2. The active stage, in which the cord begins to form near the nodule.
3. The residual stage, in which tendonlike cords are visible and the contraction between the palm and fingers becomes obvious.
Treatments for Dupuytren’s Contracture in Western Medicine
It is not usually necessary to treat this condition. However, if you develop the later stage of this condition, up to the point where your finger function becomes restricted, it may be necessary to seek medical treatment.
This treatment, currently in phase three of FDA approval, utilizes an injection of collagenase along the contracted cords. A small dosage of collagenase is best to dissolve or soften the cords.
Low-energy X-rays can also soften or reduce the contraction of the cords.
Warming up the area is important, first with heat, then ultrasound. Manual work on the hand can help remove restrictions, and should be followed by stretches to regain more motion.
Surgery for this condition consists of opening the skin over the affected cords and removing the fibrous tissue. This procedure is not curative, however, and cannot prevent the affected wrist and palm areas from developing Dupuytren’s disease again at a later date.
After the surgery, you will most likely need further surgery to clean out the remainder of the cord in your fingers. Also be advised that the surgery comes with a risk of injury to the nerves and surrounding connective tissues.
Treatments for Dupuytren’s Contracture in Traditional Chinese Medicine
Acupuncture is a minimally invasive technique. For this condition, the needles are inserted locally along the cords, and electrical stimulation is then added to the highest degree that can be tolerated. It lasts 25–30 minutes, and you are allowed to adjust the stimulation level yourself. This treatment is followed by 5 minutes of ultrasound to soften the cord. Finally, there is a massage and some stretching exercises, all of which together serve to decrease the rigidity of the cord.
|1||He Gu||LI 4|
|2||Qu Chi||LI 11|
|3||Arshi||As Fig 14.1|
Luke underwent the above combination of treatments 15 times. He was also told to soak his hand in very hot water every morning for 15–20 minutes, and to massage and stretch his fourth finger. He repeated these same stretches after acupuncture treatments in my office. After 15 visits, his condition was completely resolved. This treatment routine was also successfully tried in France in 1983, with similar positive results.
Additional Treatments for Depuytren’s Contracture
I have treated more than thirty cases of Dupuytren’s contracture and have found that the earlier the treatment, the better the results. For example, I treated a young, twenty-five-year-old man who had a family history of Depuytren’s that had passed on to him. He had developed a nodule in his right hand at the meeting point of the fourth finger and palm. Because he consulted me at the earliest stage of his condition, I was able to cure him in only six or seven visits. If treatment is begun at a very late stage, acupuncture may not be a successful therapy.
Tips for People with Dupuytren’s Contracture
- Your cooperation in the treatment procedures is very important. This includes soaking your hands in hot water for 15–20 minutes every morning and doing stetching exercises on the affected finger.
- The results will be even better if you self-treat at home by massaging Chinese herbal massage cream or oil—red flower is good—into the affected area.