Treatment Options
3) Treatment Options: The only effective treatment option for this condition is surgical. However, if the patient's condition is stable and the disease is not progressing, then the risks of surgery must be weighed against the actual decrease in the patient's quality of life due to the disease, especially in elderly patients. The patient is instructed to use heat, perform stretching exercises, and massage the palm for early treatment, in an attempt to maintain flexibility and function. Once significant functional loss has occurred, surgical treatment is justified. If only one area of the palm is involved and only one scarred band is present, then the surgeon may be able to only cut this band for relief of the contracture. This procedure is simple, but the disease has a high rate of recurrence. However, if the problem is more extensive, then the only effective option is to surgically remove the diseased fascia (termed fasciectomy). This will only solve the problem in the area removed; patients with this condition are more likely to have the condition arise in other areas, especially of there is a hereditary component to the patient's condition (runs in the patient's family). Surgical management is appropriate when the joint contracture exceeds 30 degrees.
In most cases, the surgery can be carried out under local
anesthesia on an outpatient basis. Depending on the extent of involvement,
the surgeon will remove all or part of the palmar fascia. The surgery
involves raising skin flaps and carefully dissecting out the diseased fascia
without injuring nerves which may run through the thickened tissue.
After the surgery has been performed and the incisions have healed, the
patient begins an intensive program of hand rehabilitation to restore full
use of the affected digits. This involves stretching, active motion
exercises, and nighttime extension splinting (posturing the hand in a stretched,
extended position) to restore a full range of motion.
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