Hi all,

I ve read that many of you have recommended the use of splints after treatments. My dups is at an early stage with no contracture, although my hands are becoming progressively tighter. Neither hand is ready for RT or any other treatment.

So here is my question....would you advise someone in this position to wear night splints or gloves to keep fingers reasonably straight....any other suggestions would be welcomed.....

Many thanks

Gazza

I also don't know the answer to this. I've not hand surgery or NA or Xiaplex and started wearing a splint at night because one hand was getting tight. But I didn't like the short term stiffness it induces in the finger joints. This stiffness goes after 5-10 minutes in the morning. To allay the stiffness I then ensured the splint was not straight but had a curl for the fingers, but eventually conceded that that defeated the object of keeping the fingers straight overnight anyway, so have now stopped with the splint. YMMV so you could always try it but I'm not aware of any trials on people who have not had one of the treatments mentioned.

Edited 10/15/12 09:20

There is a theory by Albrecht Meinel that postulates (not proves) that the contracture is actually a freezing of the relaxed finger position. You can watch his presentation at the Miami conference on Youtube http://www.youtube.com/watch?v=kq4hr06tOtY&lr=1 (it addresses a medical audience). It is supposed that this freezing mostly happens at nicht where the finfers are at reast and typically in a curled position. According to this theory keeping the fingers straight at night will prevent further contracture.

There is no prrof for this theory. As others already noted the progression of Dupuytren's is fairly unpredictable and proving this theory might be difficult. But still, yes maybe a splint might prevent further progression. Is it worth using a night splint for decades on the assumption that it avoids further progression? I guess that's a personal decision.

Wolfgang

I think prior splints would not be beneficial, but it could be tried. Why do you say you are not ready for RT? RT should be done before contracture. Contracture does not always occur so it would be difficult to know whether the splints worked, or not.

It is my understanding that the primary purpose of the splints after a procedure is to retrain the adjacent muscles, tendons and scar tissue to the "normal" position and not the contracted position.

I've posted earlier about my extremely positive experience with splinting, and it may be relevant here as well. (And I still owe Wolfgang an account of this experience and photos of my splint for the "Personal Experiences" section of the website... I haven't forgotten!)

Anyway, here is my splint story:

I had received RT on my right hand, which had been successful at stopping progression in all areas except for the PIP joint in my little finger. The problem might have been that I never really had a nodule in that area -- it seemed to go straight to a cord (Dr. Eaton said that happens sometimes). Since RT doesn't have the same level of effectiveness on cords, that might be why that finger continued to progress.

Anyway, by about 2 years after I noted the initial cordlike thickening in that finger, the PIP contracture had progressed to the point where I wanted to address it. Two different hand docs (including Dr. Denkler) had said that they didn’t think NA was safe for this contracture because of the location of the nerve. They recommended Xiaflex instead, but due to other health issues I am reluctant to go that route (i.e., injecting a foreign substance into my body.).

So on April 17, 2012 I sought Dr. Eaton’s opinion. At that time he measured the PIP contracture at 30 degrees. Unlike the other doctors, he said he thought I could do the NA procedure despite the location of the nerve. But he also said that I didn’t need to do NA this soon – that I could wait until the finger was in the 40 to 60 degree range --and that using a splint might buy me some time by slowing down progression of the contracture.

He gave me an Rx for a custom splint, which I had fabricated by a Certified Hand Therapist (CHT).
By the time I had the splint made (on May 2, 2012, about two weeks after I saw Dr. Eaton) my contracture had increased by 5 degrees to 35 degrees, as measured by the CHT. She was able to make the splint on the spot out of a moldable plastic material. I wear it overnight.

My use of the splint – at least so far – has been successful beyond my wildest dreams. I quickly realized that my contracture was actually diminishing. On August 1, 2012, about three months after I began wearing the splint, I returned to the CHT to get a new splint made because the contracture had diminished so much that the one I had no longer fit. She measured the contracture at 15 degrees – a 20 degree reduction over three months!

She made me a new splint, which I have continued to wear. I had kind of hoped that the contracture would go away completely, but that hasn’t happened. Instead, it has continued to hover in the 15 – 20 degree range (less when I first wake up, and increasing a bit throughout the day). But this amount of contracture doesn’t really bother me – if doesn’t really affect the use of my hands for anything that I normally do, and it isn’t even very visible unless you’re looking for it. So as long as it continues at this level, I don’t feel the need to get any treatment.

Another great bonus from the splint is that I was getting periodic cramping in my right hand from the contracture, especially at night. Sometimes I could even feel the pain all the way up my arm. The splint stopped this from happening.

So what are the downsides? I find the splint to be very comfortable and no longer even notice that I’m wearing it when I go to bed. It is true that my finger is stiff when I wake up and painful to flex, but if I work it back and forth a few times, it loosens up and the pain goes away. So that is also something I barely notice at this point. So the only real downside I can see is that I look slightly less glamorous at bedtime! But this is a small price to pay.

Next steps: At this point I am getting a lot of tightening in my left hand, with about 20 degree contractures in a couple of the MCP joints. (NOTE: I had successful RT on this hand, which reduced the nodules. But I had the RT a little too late, so cords had already formed, and they have continued to gradually tighten. I’ve found RT to be very effective at stopping the progression of nodules, and even reducing their size significantly, but unlike some people, I have never had RT loosen any existing cords.) Anyway, I am now looking into the possibility of getting a custom splint for this hand as well, in the hope that it might loosen these cords up a bit as well. I’ll keep you posted on my results.

In sum: I don’t know if my splint experience was so successful because I had already had RT on this hand or not (maybe the RT made the Dups less aggressive?) But I don’t really see much reason NOT to try a splint. If it works it would be a very non-invasive and safe solution.

If you try it, please report back to us!

Maddie