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LSU Health Sciences Center

Occupational Therapy
Dupuytrens Treatment

Carla M. Saulsbery LOTR, CHT


Dr. A. Hollister, MD

Dupuytrens
*Often cited as being of genetic origin, primarily affecting individuals of
Northern European descent.
*Associated with diabetes, hypothyroidism, smoking, chronic
pulmonary disease and seizure disorders.
*Men affected more than women, onset usually 50 to 70 years
*Active cellular process in the fascia of the hand. Pathological changes
occur in the fascia with thickening and shortening of the fascia leading to
contracture and loss of function.
*Surgery when contracture becomes a functional problem
*Therapy goal is to promote wound healing, control scar formation, increase
range of motion, provide splinting, and maximize function in ADLs
*Digital nerves and arteries (neurovascular bundles) may become shortened with
flexion contractures. These can take several weeks to grow the needed length
after contracture release.
This must be remembered during serial splinting post surgery
Avoid attempting full extension of the fingers in the first 3 weeks
*Referral to Occupational Therapy for pre-op education

Post operative therapy


Week 1 post op.
*Post operative dressing and plaster splint is removed
*Referral to Occupational Therapy for splinting, ROM, wound care
*A thin cotton dressing is applied to the hand and wound area
*A volar resting pan splint is custom molded out of X-lite. MD will note
position of MCPs. Typically the wrist is extended 45, MCPs are flexed
60-90, and the IP joints held in extension. Splint is worn day and night,
off for ROM exercises and wound care.
*Patient education in wound care
*Patient education in AROM exercises. Avoid extension at MCP
joints. Focus on IP joint extension. Watch for neurovascular bundle tension.
Avoid overstretching of nerve and blood vessels
Regain PIP/DIP joint extension. Focus on flexion and making a fist
*Patient education in no soaking of the hand until wound closure. No use of
solvents or being around solvents/ dirty environments.
*Patient education in ADLs and modifications. One handed ADLs
Edema control techniques
Semmes Weinstein if numbness is present

Dupuytrens splint

Weeks 2-4 post op


*Continue with volar resting hand splint, serial splinting into extension at the
MCP joints 15 weekly
*Patient education in gentle PIP extension stretching exercises performed
with the MCPs flexed.
Caution on preventing overstretching of blood and nerve vessels
*Continue wound care
*Patient to continue with AROM of composite flexion
*Yellow foam sponge for hand exercises
Wound care progressing to scar massage
Scar massage using cocoa butter
Upon wound closure patient can begin basic ADLs
Edema control
Often will have to hold on serial splinting the MCPs into extension until
the volar wound has healed. Work on IP joint extension

Night time resting hand splint

4-6 weeks post op


Continue scar massage
Continue volar hand splint with wrist and digits in full extension
Monitor for sympathetic response (flare)
Begin desensitization program for scar hypersensitivity
Assess grip strength at week 6 and begin strengthening
*Putty exercises at 6 weeks
Continue with PIP/DIP extension exercises
Continue to assess Semmes as indicated
6-12 weeks post op
Continue with night time splinting
Continue scar massage
Continue desensitization program as indicated
Continue to increase strength
Patient to continue increasing ADLs
Continue to monitor for dupuytrens flare
Assess Semmes as indicated
*Night extension splinting may continue for 6 months

References
Burke; Higgins; et al. Hand and Upper Extremity Rehabilitation 3rd ed. Pg 539- 545.
Elsevier 2006
Hunter, Macklin and Callahan eds. Rehabilitation of the Hand: Surgery and Therapy
4th ed. Pg 981-994. Mosby
Dr. A. Hollister, MD. Associate Professor Orthopaedic Surgery LSUHSC
Carla Saulsbery LOTR, CHT LSUHSC