Dupuytren’s Contracture-Cannabis Can Help

Dupuytrens Contracture-Cannabis Can Help

Dupuytren's (du-pwe-TRANZ) contracture is a hand deformity that usually develops slowly, over decades. Dupuytren's contracture affects the connective tissue under the skin of your palm. Knots of tissue form under the skin — eventually forming a thick cord that can pull one or more of your fingers into a bent position.

Once this occurs, the fingers affected by Dupuytren's contracture can't be straightened completely, which can complicate everyday activities such as placing your hands in your pockets, putting on gloves or shaking hands.

Dupuytren's contracture most commonly affects the ring finger and pinky, and occurs most often in older men of Northern European descent. A number of treatments are available to slow the progression of Dupuytren's contracture and relieve symptoms.

The cause of Dupuytren's contracture is not known. It is not caused by an injury or heavy hand use.

There are factors that put people at greater risk for developing Dupuytren's contracture:

  • It is most common in people of Northern European (English, Irish, Scottish, French, Dutch) or Scandinavian (Swedish, Norwegian, Finnish) ancestry.
  • It often runs in families (hereditary).
  • It may be associated with drinking alcohol.
  • It is associated with certain medical conditions, such as diabetes and seizures.
  • It increases in frequency with age.

Symptoms

  • Nodules. One or more small, tender lumps (nodules) form in the palm. Over time, the tenderness usually goes away.
  • Bands of tissue. The nodules may thicken and contract, forming tough bands of tissue under the skin.
  • Curled fingers. One or more fingers bend (flex) toward the palm. The ring and little fingers are most commonly affected, but any or all fingers can be involved. As the bend in the finger increases, it may be hard to straighten your finger. Grasping large objects and putting your Symptoms of Dupuytren's contracture include painful bumps (nodules) under the skin that develop into tight bands of tissue, causing the fingers to curl.

Dupuytren's contracture of the right little finger. Arrow marks the area of scarring
In Dupuytren's disease, the tough connective tissue within one's hand becomes abnormally thick which can cause the fingers to curl and can result in impaired function of the fingers, especially the small and ring fingers.  It usually has a gradual onset, often beginning as a tender lump in the palm.  Over time, pain associated with the condition tends to go away, but tough bands of tissue may develop.  These bands, which are the source of the reduced mobility commonly associated with the condition, are visible on the surface  of the palm and may appear similar to a small callus.  It commonly develops in both hands and has no connection to dominant or non-dominant hands.  The main function of the palmar aponeurosis is to increase grip of the hand;  thus, over time, dupuytren's contracture decreases patients ability to grip objects.

The contracture  sets in slowly, especially in women. However, when present in both hands and when there is associated foot involvement,  it tends to progress more rapidly.

Related conditions:

  • Peyronie's disease - curvature of the penis
  • Ledderhose disease - callus under the foot and possible curling under of toes
  •  
  • Garrod's knuckle - pads on the back of knuckles of fingers

There is no way to stop or cure Dupuytren's contracture. However, it is not dangerous.  Dupuytren's contracture usually progresses very slowly and may not become troublesome for years.  It may never progress beyond lumps in the palm.  If the condition progresses, nonsurgical treatment may help to slow the disease.

Needle aponeurotomy

Needle aponeurotomy is a minimally invasive technique where the cords are weakened through the insertion and manipulation of a small needle.  Once weakened, the offending cords may be snapped by simply pulling the finger(s) straight.  The advantage claimed for needle aponeurotomy is the minimal intervention without incision (done in the office under local anesthesia) and the very rapid return to normal activities without need for rehabilitation, but the nodules are not removed and might start growing again.  Foucher et al. reported that the postoperative gain is greater at the metacarpophalangeal joint level than at the interphalangeal level and found a reoperation rate of  twenty four per cent;  complications are scarce.  Needle aponeurotomy may be performed on fingers that are severely bent, stage IV, and not just on early stage Dupuytren's contracture.

Surgery

Surgical management consists of opening the skin over the affected cords and excising (removing) the fibrous tissue.  The fingers may then be brought out to length with the help of postoperative therapy.  The procedure is not curative in that remaining non-affected fascia may still develop Dupuytren's disease later on, and therefore the patient may need repeat surgery.  In addition, the thickened fascia often is near to or wrapped around the digital nerves and arteries, so there is risk of nerve and/or arterial injury.  A 20-year review of surgical complications associated with open surgery (fasciectomy) for Dupuytren's showed that major complications occurred in 15.7%,  including digital nerve injury 3.4%,  digital artery injury 2%, infection 2.4%,  hematoma 2.1%,  and complex regional pain syndrome 5.5%  in addition to minor complications including painful flare reactions in 9.9%,  and wound healing complications in 22.9%

Radiation therapy

Radiation therapy treatment of Dupuytren's contracture with low energy x-rays,  has shown some promise in trials lacking a control group

Alternative therapies

A number of compounds claim to provide benefit, but there is little or no experimental evidence to support these claims.

  • Quercetin
  • Bromelain
  • DMSO
  • MSM
  • Acetylcarnitine Hcl
  • PABA
  • Nattokinase
  • Vitamin E (treatment from the 1940’s)
  • Copper
  • Vitamin C
  • Massage

Nonsurgical Treatment

Steroid injection. If a lump is painful, an injection of corticosteroid - a powerful anti-inflammatory medication - may help relieve the pain. In some cases, it may prevent the progression of contracture. Several injections may be needed for a lasting effect.

Splints. Splinting does not prevent increased bend in the finger. Forceful stretching of the contracted finger will not help either, and may speed the progression of contracture.

Surgical Treatment

Surgery is recommended when your doctor has confirmed through measurements over time that the disease is progressing. Some patients turn to surgical treatment when hand function is limited; they have trouble grasping objects or putting their hands in their pockets.

Surgical procedure. Surgery for Dupuytren's contracture divides or removes the thickened bands to help restore finger motion. Sometimes the wound is left open and allowed to heal gradually. Skin grafting may be needed.

Complications. Although rare, risks of surgery include injury to nerves and blood vessels, and infection. Permanent stiffness of the fingers may occur, although this is also rare.

Treatment

Amputation  of fingers may be needed for severe or recurrent disease, or after complications in surgery.  Exercises, warm water baths, or splints may be helpful.  Surgery, to release the contracture, depends on the severity of the condition.  Normal movement of the fingers is usually restored by surgery and followed by physical therapy exercises for the hand.

Recovery. Some swelling and soreness are expected after surgery, but severe problems are rare.  After surgery, elevating your hand above your heart and gently moving your fingers help to relieve pain, swelling, and stiffness.  Physical therapy may be helpful during recovery after surgery.  Specific exercises can help strengthen your hands and help you move your fingers.

Most people will be able to move their fingers better after surgery.

Needle Aponeurotomy

Needle aponeurotomy is another new, less invasive procedure being performed by surgeons trained in the technique.  After numbing the hand with a local anesthetic injection, the surgeon uses a hypodermic needle to divide the diseased tissue.  No incision is required and this procedure can be done in the doctor's office. Complications are no greater than with surgery, and the patient experiences less pain and swelling immediately after the procedure.  Early results appear equivalent to surgery, but long-term recurrence rates are unknown.

Expectations (prognosis)

The disorder progresses at an unpredictable rate.  Surgical treatment can usually restore normal movement to the fingers.  The disease can recur following surgery in some cases.

Complications

Worsening of the contracture may result in deformity and loss of function of the hand.
There is a risk of injury to blood vessels and nerves during surgery.
Actors David McCallum, and Bill Nighy, politicians Bob Dole and Ronald Reagon, Margaret Thatcher all suffer(ed) from the condition.

Medical Marijuana:

While getting all the other treatments available, use cannabis (medical marijuana).  The cannabinoids will relieve many of the symptoms of Dupuytren’s Contracture.  CBD-cannabidiol has proven therapeutic value.  Use it for pain and inflammation relief.

Best Strains:

Dream Queen (sativa dominant), The Purp, OG Kush, Cali Gold, Trainwreck (sativa dominant), Death Star (indica dominant), God Bud (indica hybrid), Hog (indica hybrid), Ice Queen, Super Lemon Haze, Cheese (sativa dominant hybrid), Sublime (unknown), Purple Urkle, Blackberry Kush, Herijuana (indica top medical strain), Marilyn Monroe (indica dominant), Silver Haze (sativa), Accidental Tourist (S/I hybrid)

References



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