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Dupuytrens contracture.
I have a client with this condition. I would love to hear any feedback you can give re effective recovery and which massage techniques you have used.
Thanks Steve
http://www.ealingmassagetherapy.co.uk/Dupuytrens-Massage.html
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Replies to This Discussion
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Permalink Reply by Lara Rininger on
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Hi Stephen-I treated a client in our student clinic with Dupuytrens. Local application of moist heat may help soften the fascia. I used friction to loosen scar tisue, kneaded the palms and did gentle extension movements to the fingers and wrist to my client's tolerance. She especially liked the gliding and kneading strokes to her forearm muscles that I did to help increase circulation to those areas. Find out if the affected area has sensation- if not, then use only light to moderate pressure. You can also place the affected hand and wrist palm down on a bolster with a rolled up washcloth in their palm while you massage other areas. I have heard and read that contractures are difficult if not impossible to reduce with massage. I believe that if it is a serious disability typical tx is surgery to release the restricted tissues. That said, I think it depends on the cause of the contracture in the first place to know whether or not massage will be effective in treating it.
I am limited in my experience and knowledge of this condition having only recently completed school so I hope other therapists on here will chime in with some more helpful information for you so I can learn more too.
Lara
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Permalink Reply by Stacey Barrett on
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Stephen.
I have had really great results with Dupuytrens, I currently have 4 clients who have had treatments on it.
With deeply set dupuytrens they get more ROM and pain relief, but most times it has gone untreated for many many years as doctors do not think to refer to RMTs for it. Too bad because I have found if it is treated early then it just doesnt progress.
For people with a newer or milder case, the progress is amazing. However, even with the worst cases they get relief.
It is a fairly aggressive approach, and I have lots of experience with myofascial release and deep tissue work & I do not recommend just jumping into deep work if you are not used to it. I work the heck out of the tendons, Long slow stripping of each tendon & ART type stretching with massage. It will be very hard on your hands as it is such small work. plus I do the retinaculum, thenar web & eminence (I find very important with all palmar issues)...all compensating muscles etc etc. I also do a light stretch after, each individual finger.
They immediately will have increased range of motion & each time they come in the range will stay longer. Sore for two days post (lactic acid) and then feel fantastic.
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Permalink Reply by Al Meo LMT,CN,CPT on
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Hi Stephen, I have found the Radioulnar, wrist, and hand protocols with Active Isolated Stretching to be amazing with these contractures. I believe you will be able to release the structure, there will be homework for the patient/ client though. Hope this helps, I am sure you will find it of benefit to yourself as well...Good Luck!
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Permalink Reply by lee kalpin on
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I agree with Stacey. I have also had good results with this condition when I have been able to treat before it becomes to advanced. This has happened when I am treating the client for something else, or even doing a relaxation massage, and discover that they have early-stage Dupuytrens
Even in more advanced cases, I have been able to prevent it from contracting further, and restore some range of motion.According to the textbooks, this condition tends to be hereditary and I have confirmed this by asking clients if someone else in the family has it. They usually tell me that a father or grandfather has the condition.
Stacey Barrett said:Stephen.
I have had really great results with Dupuytrens, I currently have 4 clients who have had treatments on it.
With deeply set dupuytrens they get more ROM and pain relief, but most times it has gone untreated for many many years as doctors do not think to refer to RMTs for it. Too bad because I have found if it is treated early then it just doesnt progress.
For people with a newer or milder case, the progress is amazing. However, even with the worst cases they get relief.
It is a fairly aggressive approach, and I have lots of experience with myofascial release and deep tissue work & I do not recommend just jumping into deep work if you are not used to it. I work the heck out of the tendons, Long slow stripping of each tendon & ART type stretching with massage. It will be very hard on your hands as it is such small work. plus I do the retinaculum, thenar web & eminence (I find very important with all palmar issues)...all compensating muscles etc etc. I also do a light stretch after, each individual finger.
They immediately will have increased range of motion & each time they come in the range will stay longer. Sore for two days post (lactic acid) and then feel fantastic.
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Permalink Reply by Stephen Jeffrey on
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I'd like to report that in giving full consideration to the reply's posted here and futher research by myself and my client
( a dentist who was in early stage of contracture ), that although he has had just 2 (20 min) sessions, the results are nothing short of amazing. The thickness of the contracted tissue is markedly reduced, and of the 2 (pea sized ) knots within the contracture = one is now 80% reduced, the other spontanously released completely on the second session!.
My experience
Palpation At the first session the contracture palpates as the most unuasual, tight, hard, tissue that I have ever previously palpated. presenting inline with the tendon and through the palm ending proximal to the carpal tunnel. The client reported it as numb rather than painfull.
Techniques General petrisage on whole hand then light, then medium, then deep, cross fiber frictions along the length of the contracture and into 2 large knotts in the middle of the contracture.
Then 4 slow compressions along the length of and into the contracted tissue/knotts. ( thumb or finger pressure that first engages the tissue, Waits, then Follows the release.
The above was used in exactly the same way in both sessions.
Remarks because the tissue palpates as unuasually/extreamly tight/hard the actual tissue release phase, is itself a profoundly unique experience for both you and your client.
Advice experienced massage therapists that can confidently and sensitively apply frictions and compressions should be able to acheive simular results in what is very intricate work.
Failure to act to catch the symtoms early as lee and Stacy sugguests may lead to your client needing surgery, see you tube clip.???
http://www.youtube.com/watch?v=yjYRlo_Zupw
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Permalink Reply by Gordon J. Wallis on
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I just wanted to see if anyone in here had ever worked with trigger finger because I had an out of town client come in for just one massage..She had trigger finger...She had it for three months..When she gets home, she will get surgery on it..Her doctor said that was her only real option..But about twelve years ago, I got trigger finger myself..Being stupid and pressing to hard on a client..Anyway I told her that my trigger finger was extremely painful too, At the time I was told by a medical doctor that there was no cure, and that surgery was the only option. I remember being really worried about my career. However I kept massaging it myself, stretching as best I could....And to make a long story short...Six months later..No more trigger finger(a thumb in my case.). I had no particular techniques other then to keep things in the hurt good zone as much as possible, and move it as much as possible...It took six months... So you will be able to help her....but it might take some time...Its a tendon injury as well...that takes time....but massage does work..My trigger finger(thumb) was BAD.. I also remember soaking it in hot and cold water a lot. I would remind her to be patient, she will have to work on her self a lot.
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Permalink Reply by Tracy Hristov on
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Hi, Steve. This is interesting. Apparently the doctors don't know the cause for Dupuytrens. http://www.mayoclinic.com/health/dupuytrens-contracture/DS00732/DSE... I believe massage is very beneficial. I also have experience with a client whose pinky finger is curling towards his palm. I like Laura Rininger's reply. Also I suggest manipulation of all the hand flexors an extensors since this disease may eventually cause disability to the ring finger and possibly the third phalange. Hope you check out the link.
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Hi Tracy
thanks for your reply and link, I continue to collect as much information as possible because as you suggested Doctors and researchers don't know what causes Dupuytrens contracture and their standard advice is to wait and see how bad it gets???
This unfortunately means that often the client does nothing, and the cords begin contracting ( up to 15 degrees contracture is stage 1 ). By treating as soon as the nodules and cords are present, there is a much greater potential to halt the contraction process and normalise the fascia cells effected.
I have provided this web page for sufferers on my web site, you may want to view the references at the bottom of the page
http://www.ealingmassagetherapy.co.uk/Dupuytrens-Massage.html
At its worst, the condition can go on to affect every finger and thumb, cause fibromatosis in the feet (Ledderhose disease) and rarely peyronies desease. Sometimes the sufferer even resorts to amputation when surgery or other interventions fail.Early treatment is vital.
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Currently, DCI is very close to completing a research project to develop a method to specifically stretch the palmar soft tissue nodules and finger contractures. If you are interested in learning about this new Dupuytren research, please send an email to Dr. Herazy at herzy@sbcglobal.net and ask for information about “Hand Contracture Graduated Stretching.”
Further, DCI is beginning another research project to develop a special method to deliver a Dupuytren massage without risk of aggravating the hand contractures. If you are interested in participating in this Dupuytren massage research, please send an email to Dr. Herazy at herzy@sbcglobal.net and ask for information about the “Dupuytren Massage Project.”
You can always email as well and see what has worked for them.
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Hi, Stephen.
That's an important link that you've shared. Thanks! I believe massage could actually prevent the cords and nodules from ever forming. As you stated, "Early treatment is vital." This is also just one other condition that proves that if it goes untreated that is can influence the development of further and additional disorders and diseases. Hopes for more discovery and treatment!
Stephen Jeffrey said:Hi Tracy
thanks for your reply and link, I continue to collect as much information as possible because as you suggested Doctors and researchers don't know what causes Dupuytrens contracture and their standard advice is to wait and see how bad it gets???
This unfortunately means that often the client does nothing, and the cords begin contracting ( up to 15 degrees contracture is stage 1 ). By treating as soon as the nodules and cords are present, there is a much greater potential to halt the contraction process and normalise the fascia cells effected.
I have provided this web page for sufferers on my web site, you may want to view the references at the bottom of the page
http://www.ealingmassagetherapy.co.uk/Dupuytrens-Massage.html
At its worst, the condition can go on to affect every finger and thumb, cause fibromatosis in the feet (Ledderhose disease) and rarely peyronies desease. Sometimes the sufferer even resorts to amputation when surgery or other interventions fail.Early treatment is vital.
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Hi Roeh
do you intend taking part in this research ? if so, it would be great info to post here, protocols etc.
Why not ask Dr Herazy to post some info on this thread ? it would be great to hear from someone long term involved with massage and the treatment of Dupuytrens !
Did he attend/present at the Miami Dupuytrens Symposium in 2010 ?
Although none of these presentations refere to massage therapy I learned a great deal about the condition, anatomy, research, enzyme injection, surgery etc here http://www.youtube.com/results?search_query=Dupuytrens+symposium&am...
Roeh Dale Gill said:Currently, DCI is very close to completing a research project to develop a method to specifically stretch the palmar soft tissue nodules and finger contractures. If you are interested in learning about this new Dupuytren research, please send an email to Dr. Herazy at herzy@sbcglobal.net and ask for information about “Hand Contracture Graduated Stretching.”
Further, DCI is beginning another research project to develop a special method to deliver a Dupuytren massage without risk of aggravating the hand contractures. If you are interested in participating in this Dupuytren massage research, please send an email to Dr. Herazy at herzy@sbcglobal.net and ask for information about the “Dupuytren Massage Project.”
You can always email as well and see what has worked for them.
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No I am working on my own research between CD and MS and the effects of different types of massage and what they do.
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