There have been many times over the course of my career as an Occupational Therapist and a Certified Hand Therapist that I have wished that I had a magic wand to wield.  But, alas, although the body has this incredible capacity to heal injury and remodel scar over a period of time, the recovery process is a journey rather than teletransportation.  So, when I came across a Facebook advertisement several weeks ago for a company that is touting a "magic wand" to "cure" Dupuytren contractures, I felt compelled to respond.
Dupuytren Disease is a genetic predisposition of the tissue under the palm of the skin to over-develop and create bumps, dimples and nodules in the palm.  If the disease progresses, the nodules may become cords or bands that wrap around the finger tendons, pulling the fingers into a bent and contracted position.  Dupuytren Disease occurs more commonly in men of Northern European descent and is frequently called "The Viking Disease".  The chance of developing Dupuytren contractures becomes more common as a person ages.
It would be wonderful if we could count on magic as a cure for disease, particularly in these times of global distress with the COVID-19 pandemic.  However,  especially now, it is important to lean on science and facts rather than wizadry and supposition.  It is also the time to question the motives of those trying to sell us vaguely defined products with huge promises but no details.
Let's take a look at some Dupuytren facts versus magical fiction:

• Unfortunately, there is no cure for Dupuytren Disease....yet.  Dr. Charles Eaton from the Dupuytren Research Group is conducting ground-breaking research to find the cure.   (Click here if you are interested in enrolling in the research project.  Dr. Eaton is looking for those who currently have Dupuytren Disease as well as for control samples.)
• Although there is currently not a cure, there are excellent medical procedures that can reduce the impact of finger contractures on functional hand use.  Whether performing a surgery or using an enzyme or a needle to sever the cords and improve finger mobility, skilled surgeons with scientific and medical training and knowledge of Dupuytren Disease are the true wizards in this field of practice.
• The "pioneers in energy medicine" are promoting a "magic cure" for Dupuytren Disease to convince you to buy a "magic wand".  This wand is actually an ultrasound machine.  Ultrasound is not new technology.  As a therapist, I use ultrasound with great success when I'm using it for appropriate conditions and applying the proper techniques.  Unfortunately, there is absolutely no scientific evidence that shows that ultrasound "cures" Dupuytren Disease or is an adequate alternative to a surgery or procedure.  And without the knowledge of the proper frequency and parameters with which an ultrasound application should be performed, damage can be done to soft tissues.  If the use of ultrasound was a true cure for Dupuytren tissue, it would have been used ages ago.  I will admit that I do not use far infrared light, the second component of the supposed "magic wand", in my clinic, but research shows that infrared light is a form of deep heat.  Heat application will temporarily cause some increased flexibiity in tissue, but it will not loosen fixed contractures.  Again, not a new technology that would be standardly used if it was truly beneficial to Dupuytren treatment. 
  
• If you do choose to take a chance on the "magic wand",  buyer beware. The Dupuytren "magic wand" as advertised does not specifiy any parameters whatsoever in the product description.   Most portable ultrasound machines available are 1 MHZ which penetrates too deeply for a hand injury and can cause deep aching or worse.  A hand injury is a shallow injury requiring a 3 MHZ machine to target the appropriate tissue depth.  Unfortunately, we have no clue as to what is being purchased on this particular "magic wand" website.
  
• The "magic wand" is also advertised as a device that helps alleviate the pain associated with Dupuytren Disease.   The truth is, occasionally, in the early stages of development, a Dupuytren nodule may be inflamed and painful.  This inflammation typically burns out quickly.  Infrequently, the nodule will press on a nerve and require more immediate medical attention.  But, good news... these cases are truly the exception.  Dupuytren is very rarely painful.  It is an over-production of collagen tissue that causes a contracture and loss of mobility rather than a painful condition. 
• The best news....the number of Dupuytren nodules or lumps that progress to the point that a surgery or procedure is needed to straighten the finger is far outnumbered by those that never require medical attention.
• It is thought that the body, in an attempt to protect us,  develops the increased collagen associated with Dupuytren Disease in response to a perceived threat.  Aggressive exercise, stretching and massage techniques will likely cause the symptoms to progress more rapidly.  Avoid any aggressive Dupuytren treatments or splinting prior to having a susrgery or procedure.
  
• The best way to treat an early occurrence of a Dupuytren nodule, bump or dimple is to just let it be.  Consult with a physician first to make sure that it is indeed Dupuytren's that you are dealing with and not another condition that may be causing your symptoms.  If the finger is bent less than a 20-30 degree angle, if it is not painful, and if it is not impacting function, the physician will likely recommend a wait-and-see approach. 
  
• Some things that you can do:
  

1. Use a 3/4 finger glove with padding in the palm if you use your hands for work or sports activities that cause impact or vibration against the palm
2. If you are diabetic, keep blood sugars under control.
3. Avoid heavy alcohol intake.
4. Do not smoke.

In summary, as much as we all of us would like to believe that magic truly exists, don't trust empty promises. Seek reliable sources for any medical condition. The Dupuytren Foundation, the American Association for Hand Surgery, the International Dupuytren Society, and the American Society of Hand Therapists are all good resources to improve your Dupuytren knowledge.
If you do have a Dupuytren procedure performed and would like additional information on the rehabilitation aspects of recovery, please visit my Dupuytren website:  dupuytren-contractures.weebly.com

 Black Friday, Small-Business Saturday and Cyber Monday are once again upon us.  Are you looking for the perfect gift for family, friends or co-workers who suffer from the pain of carpal tunnel syndrome, tendinitis, or arthritic hand joints?  Or perhaps you deserve to treat yourself??
Here are my top 10 picks (plus 1 bonus) of items that I frequently recommend for my hand therapy clients - in no particular order.

A new recommendation this year to my gift list of frequently recommended products is the UnBuckleMe infant carrier and child car seat unbuckler.  I saw it first demonstrated at our annual hand therapy conference and purchased one for my co-worker who was having some thumb pain when releasing her grandchildren from their seats.  It works as advertised.   Designed by an occupational therapist who has arthritis, this product reduces the force of unbuckling infant and child car seats by more than 50%.  

As the prices have come down making these paraffin was units more affordable for an at-home-spa treat, I find myself recommending them more and more frequently to my clients.  A paraffin bath is not only good for relaxation but can help ease the deep ache caused by many hand injuries.  The deep heat coating the hand is good for increasing the flexibility of joints and easing joint pain caused by arthritis.  The mineral oil in the wax as well the direct application onto the hand can help to soften a thick scar.

 Kinesiotape was developed by Japanese physician Dr. Kenzo Kase over 25 years ago "as a sports taping method which could assist in the healing of traumatized tissue and muscles."  Kinesiotape was the original brand.  Made popular by KT Tape with the application on 2008 Olympic athletes, now over 150 brands are available and the use of this therapeutic taping techniques has became a widely used modality that we provide to a number of our clients on a daily basis as part of their treatment plan.  Seen on many athletes, therapeutic tape does not bind the joints for support the way athletic tape does but rather lies on the muscle belly.  The wave-like pattern of the adhesive, as well as mild stretch, lifts the surface of the skin, increases lymphatic and blood flow to the area, and relaxes the tissues around the superficial free nerve endings - providing some instant pain relief for most people!  Instructions for application are usually provided in the box.  There are also multiple online videos that show proper application.  Base your purchasing needs on cost, colors and patterns, water resistance level, and latex sensitivity.

Another product that premiered at our annual hand therapy conference several years ago is the Lazy Hands phone grip that comes with 2, 3 or 4 loops providing a secure grip on Smart Phones or Tablets and eases hand tension created by holding devices.  There are now some alternative methods on the market as well including phone rings that can alternatively act as a stand and the commonly seen pop-sockets.  I have a Lazy-Hands for demonstration purposes in the clinic that I may eventually claim for my own.  I currently use a pop-socket, which is helpful, but does not feel as secure.  Also, if the phone happens to heat up, the adhesive softens and the pop-socket will occasionally slide or even pop off.  In spite of this, the pop-socket is much more secure than I thought it was going to be.

Always high on my recommendation list for those with hand injuries or pain are ergonomically-designed accessories to improve the use of electronic devices.  I often demonstrate the  following pieces of equipment in the clinic:

• A Split Keyboard - As computers and portable devices have become smaller so have keyboards.  This makes it more difficult to maintain a good, neutral wrist posture while typing.  Those keyboards that have the inverted "V" down the middle help align the fingers with the forearm easing tension on the sides of the wrist and preventing wrist pain and tendinitis.
• A Vertical Mouse - Using a mouse that is turned onto its side places the forearm in a more neutral position and can ease mousing pain.
• A Laptop Stand with a Free-Standing Keyboard - Although the portability of laptops make them a wonderful choice for those on-the-go, inherently the design will place either stress on the arms or stress on the neck.  When at home, turn your laptop into a more ergonomically friendly desktop device by using a stand with an accessory keyboard.
  

When many people write, they use much more tension than they realize.  For those who have hand pain or injury, using a larger barreled pen such as the Dr. Grip, a felt-tip pen that writes smoothly, or an ergonomically designed pen such as the PenAgain can ease thumb pain and hand cramping.  I have used and recommended all of the following.

For those with hand pain or injury, using gadgets and gizmos designed to improve the way we work and the way we organize activities can be quite helpful.

• Changing to a larger handle, and using leverage rather than grip, are all methods of reducing joint stress.  Designed with larger handles and a textured surface that lets the hand grip with less force, the OXO brand is a good example of a company that has designed products specifically for arthritic joints and those with hand pain.  Bed, Bath and Beyond usually has a large display of the various kitchen tools.  WhateverWorks.com offers both a  website with a paper catalog filled with functionally-based products.
  
• Another method of reducing hand stress and pain, go high-tech and find electronic gadgets that can ease the work that the hands do (such as electric can-openers, electric jar openers, electric knives).  Often these products can be found at discounted prices during this time of year.

Give a book that gives the gift of health.   I have the following books available as a resource in the clinic for my clients.

• For those suffering with carpal tunnel syndrome, tendinitis and other repetitive injuries, Dr. Pascarelli, one of the leading experts on repetitive strain injuries, has written several easy-to-read but informative books including the Complete Guide to Repetitive Strain Injury: What You Need to Know About RSI and Carpal Tunnel Syndrome or Repetitive Strain Injury: A Computer User's Guide.
  
• Playing (Less) Hurt: An Injury Prevention Guide for Musicians, written by Janet Horvath,  is a book that I recommend to any client who plays an instrument, whether a professional or amateur. This book is filled with good tips.
  
• Caring for the Painful Thumb - More Than a Splint, was written by Jan Albrecht, an Occupational Therapist and Certified Hand Therapist.  This book includes tips, therapeutic taping  and exercise information.
  

Essentials for every household, for both temporary and chronic injuries, both heat and cold can temporarily change the way that pain signals travel along the neural pathway to be recognized by the brain.  Cold is great for acute inflammation while heat can be good for more chronic pain, particularly a nervy type of pain.

Head Space and Breathe 2 Relax are just two of many free apps, paid apps or apps requiring a paid subscription that can provide guidance in relaxation techniques, meditation and mindfulness approaches, deep breathing instruction and stretching guidance that will help reduce muscular stress and tension.

Smart watches, fitness trackers, digital assistants and wearable tech is a rapidly changing arena for health promotion.  The next few years will see many changes and offer new methods of health assessment and healthcare delivery.  The Apple watch and other wearable tech and our digital assistants such as the Amazon Echo can now provide timely reminders to move if we're too sedentary, to take deep breaths if our heart rates increase, provide us with guidance in workout and stretching routines, and provide us with feedback about current behaviors and suggestions on how to improve our health. It will be fascinating to see where this ground-breaking technology takes us in the next few years.  

Happy Shopping!  Marji