Dupuytren Contractures: Magic Cures versus Science

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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