Successful Dupuytren treatment demands that you know the exact limit of your hand contraction each step of the way
The Dupuytren Hand Contracture Caliper is a requirement for good results with self-directed Dupuytren treatment. You must know how much your hand is contracted and finger movement is limited in order to guide your therapy plan to a successful conclusion. Otherwise you are only guessing about your hand contracture, and that does not help you regain full use of your hand.
People are wrong to only pay attention to the obvious palm lumps and finger cords of their Dupuytrens contracture. The Dupuytren Hand Contracture Caliper makes it easy to know exactly how much their finger contracture is affecting hand movement and flexibility.
The DCI caliper with built-in measurement scale will help you easily and accurately determine reduced finger and hand movement caused by Dupuytrens disease. With it you will document how far your finger contraction is kept flexed toward the palm or wrist, as well as the other important measurement of how far your palm is kept from flattening against a table top or other flat surface. These two numbers are essential baseline measurements to determine progress, or lack of progress, of your self-directed Alternative Medicine Dupuytrens treatment.
If you do not know the true state of your bent finger and hand contracture at the start of care you will never know exactly how much improvement you have made, or if you have made any at all. You must know if you are making actual progress over your Dupuytren hand problem because this information will tell you if and when to change your treatment or perhaps not change it at all.
Many people think, “I’m not stupid. I will know if my finger is improving. I do not need to measure.” But they find after a few weeks of treatment they are totally unsure if the progress they think they have made is real or just a hopeful product of their imagination. Armed with this valuable information you will know if and when to change a treatment plan that is not working, or to keep following a treatment plan that it is working. Either way, for best treatment results you must not guess about any of this.
Using the DCI caliper to measure contracture of the hand:
- The caliper is tightened or loosened by using the large plastic knob at the pivot in the middle. The caliper has two pairs of “legs.” The “inside legs” are used to measure the inner distance of a closed surface, and the “outside legs” are used to measure an outside surface. The inside legs of the caliper are straight but bent only at the very tips to look like the letters “J” and “L.” The outside legs are rounded to look like big pincers or the letter “C.” To measure with either the inner or outer legs the caliper must be positioned so the straight legs are crossed over each other and the curved millimeter (mm) scale to provide a distance reading, just as you see it in the picture, above.
- Adjust the large plastic knob in the center of the caliper so the legs move with moderate resistance; this assures your measurements are accurate. The knob must be loose enough that the legs move with some ease, but tight enough that they do not move once you put them in position.
- Each line on the curved scale represents 2 millimeters (mm). The scale ranges from 0 to 200mm.
- Position the tips of the straight inside legs so the “J” and “L” touch each other. Notice that the edge of the moveable leg touches the “O” on the mm scale, meaning no millimeters. When the tips of the inner legs are 50mm apart the tips of the outer legs are also 50mm apart.
- Either half of the caliper – the “inside legs” or the “outside legs” – can be used to document improvement of your limited finger and hand movement. Use either side or pair of legs that is more comfortable or whichever one works best for your circumstance since the measurement will be the same.
Marking hand and fingers for measurement
Each time the hand is measured the same pair of reference points must be used, and the information must be written down for later comparison using the “Caliper Hand Measurement Chart” you received with your DCI Hand Caliper.
It is best to use naturally occurring landmarks on the fingers, palm or wrist of your hands if they are small enough to make a precise measurement, and if you will be able to easily find the same landmark each time you use the caliper for hand and finger measurements.
Locate a small and easily recognized natural landmark on the involved finger and hand. These two points should be obvious and easily located each time you measure your progress. Carefully place a dot precisely at the point you wish to use each time you measure. Using large dots or different point locations make inaccurate readings that cannot be compared over time, and this does not help you to know if you are progressing or not.
- When taking measurements for the first time write notes or make a quick drawing of the local area that explains each point location in a way that is easy for you to understand and duplicate. For easy reference, write the notes that describe the points you are using on your “Caliper Hand Measurement Chart.
- Mark you skin with a fine felt tip or ballpoint pen to clearly identify the exact points you will use each time to make your measurements.
- Examples of natural landmarks on your fingers, hands or wrists that will increase the speed and accuracy of your measurements:
a. Where a fingernail has a natural vertical ridge or flaw that does not change.
b. Where the fingernail bed and skin touch at the end of the finger (that little corner location where you might sometime get a hang nail). Use the same fingernail corner each time.
c. The very tip of your finger; it is the highest point when you look at your finger from the front and from the side view.
d. At the base of your palm, on or near the wrist crease, find a point where two or three creases meet to form a “V,” “X” or “Y”.
- Slightly bend your wrist. Notice if one or two wrist creases create a nice landmark that will be easy to locate each time you want to measure your progress. A crease or wrinkle of skin may cross over a vein, tendon, scar or blemish, making a precise reference point.
If all else fails you can locate the center of the wrist crease using a ruler, although this is much more difficult and less precise.
Measure distance bent finger flexed toward palm
Each time you how close your finger is kept flexed toward your palm you must use the same two reference points on the finger and palm or wrist. If you have Dupuytren contracture of one finger you will use two reference points. If two fingers are flexed toward the palm of one hand, three reference points are needed (one on each finger tip and a single point on the wrist). Three fingers require four points for measurement. You will make a mark on the fingertip of each involved finger and you will use the same point on the palm or wrist as a reference point for each finger.
- Mark each involved finger – Find a natural landmark or locate the center of the fingertip, as described above, of each finger affected by Dupuytren contracture. Place a small precise mark at each point.
- Mark the palm or wrist – Find a natural landmark or measure for the center of the wrist crease, as described above. This wrist point does not have to be in direct line with the involved finger(s); it can be off to an angle or side of the wrist. The only rule is that you use these same points each time you measure.
a. The wrist point can be located on the palm-side at the center of the wrist, or at an angle off toward the thumb or little finger side of the wrist crease; it can be anywhere on the crease as long as it easy to locate accurately and can be duplicated each time a measurement is made.
b. If two or more fingers are involved on the same hand, the same palm or wrist point is used as the reference point for all fingers of that hand.
c. Open your hand as far as possible.
d. Place the tips of two caliper points (either inner or outer legs) on the small dots you selected at the finger and wrist points.
e. Write the millimeter (mm) distance, as shown on the curved caliper scale, on your measurement record.
Measure amount of hand contracture
Each time you measurement your inability to flatten your hand on a tabletop, you must use the same two reference points.
If you find that only one side of the hand is kept from flattening out, and the other can be made flat, then you need to only measure the side that cannot be flattened. If both sides are kept from flattening, then you should measure both the little finger and index (pointing) finger side of the hand.
- Locate a deep wrinkle or crease that is near the knuckle that cannot be flattened. Place a small dot at the end of the selected crease or wrinkle to serve as the landmark or reference point for that joint.
- Mark the side of the finger joint or knuckle that cannot be flattened against the table top. The 1st point can be anywhere on the side of the knuckle that is a naturally occurring landmark; it does not have to be in the center of the joint.
- The 2nd reference point in this measurement is the tabletop the hand is resting on, and therefore does not have to be marked.
- Place your hand on a table top or similar surface. Press the hand down firmly so the palm is as flat as you can make it.
- Using one leg of the inside caliper (with the long straight legs), allow it to touch the dot on the side of the knuckle.
- Using the other leg, place the tip on the flat surface directly below the mark you placed on the knuckle being measured. Do not place the tip of this leg at an angle or far from the knuckle being measured. If you are not careful with this tabletop point selection you will add a variable to the measurement that will make comparison of other measurements invalid and inaccurate.
5. Write the millimeter (mm) distance, as shown on the curved caliper scale, on your measurement record.
6. To measure the distance the joint on the other side of the hand is being kept from flattening against the tabletop, repeat steps 2-7.
This is the measurement form that comes supplied with the caliper to record increased finger and hand movement. You will need good records because they are essential to know when to alter your Dupuytren treatment plan and how to do it.
© Copyright 2004-2012. Dupuytren Contracture Institute, Arlington Heights, IL 60004, and Online Natural Healthcare LLC All rights reserved. Unauthorized use or copyright violation, without written permission, will be prosecuted to the full extent of the law.
No confident answer can be given to this question based on this single finding of fingers that are stuck in the bent position. One of the possible reasons for fingers that won’t straighten out is Dupuytren contracture.
Good news about Dupuytren contracture treatment and those bent fingers
Surgery is not always necessary to restore the limited finger movement of Dupuytren’s contracture. Since 2002 the Dupuytren Contracture Institute has helped people from all parts of the world use natural Alternative Medicine therapy to help those who can’t extend their fingers because of DC. Our position has always been that while hand surgery is always an option, it makes sense to first attempt non-surgical treatment and therefore possibly avoid the inherent risks of surgery.
What is Dupuytren’s contracture?
Dupuytren’s contracture is a soft tissue problem of thickening and shortening of the deep supporting tissue of the hand (palmar fascia), found immediately above the bones and tendons and below the skin of the hand. This thickening and shortening that takes place below the skin surface causes lumps on the palm of the hand that results in constricted fingers that are bent down toward the palm preventing the hand from being opened without pain.
Dupuytren hand contracture is slowly progressive as the nodules or lumps on the palm of the hand cause the involved fingers to not straighten out and permanently get stuck in the flexed position with the fingertips toward the palm. Both hands are affected half of the time, and the right hand is more often affected when only one hand develops the problem. One or more fingers can be affected at the same time; usually the ring finger won’t extend or the pinky finger won’t extend – or both fingers can’t open normally.
The cause of Dupuytren’s contracture is unknown, but it does appear to have some strong genetic association since seven out of 10 people who are diagnosed with Dupuytren contracture have a family history of the condition. Further supporting the genetic input of these hand nodules is the finding that those people who have a Scandinavian or North European ancestry (Ireland, England, Wales and Scotland), are far more likely to develop hand nodules than dark skinned people. It is more common in those over 40 years of age, and men (70%) more often women (30%). There is still controversy and diverse opinion about the unclear relationship of other disease and environmental factors and the development of Dupuytren contracture:
- Liver disease
How do I know it is Dupuytren that is causing my fingers to not straighten out?
As discussed above, there are more than one reason to explain why the pinky and ring finger won’t extend. The reader can develop a fairly confident conclusion if the hand stiffness is due to Dupuytren contracture when several of these factors are present:
- Age 40+
- Family descended from England, Ireland, Scotland, Wales, or a Scandinavian country
- One or more family members have Dupuytren contracture
- Palm lump at the base of the pinky and/or ring finger
- Treated for epilepsy
- Alcohol abuse or liver disease
Is this the only thing that could cause my ring finger to not straighten out any more? Why do I have a bent little finger now?
First, let’s consider the obvious cause for a lump or density to appear on the palm of anyone’s hand, so you do not have to worry this common and normal palm nodule. If you have recently begun using your hands in a new way (a new job in a factory or construction, recently started a hobby like gardening or wood working, or heavy housework for a few days in the springtime), that small painful palm lump might be a callus. Think back to what new activities, or greater work associated with old activities, that could prove your hand nodule is nothing abnormal.
If you cannot otherwise account for the new lumps on the palms, then it could be a rather common condition called Dupuytren’s contracture.
Let’s also consider another explanation why the hand will not open as it once did: trigger finger (stenosing tenosynovitis). This is really not anything more than a swollen tendon in the palm of the hand that periodically locks up finger movement when it encounters a narrowed part of the tendon sheath that surrounds it. Any finger or thumb can display a trigger finger reaction in which the affected digit suddenly catches while in a bent position and just as suddenly releases the hold – like a trigger when it is pulled and suddenly snaps as it is released. Trigger finger can be occasional or frequent, mild or severe, locked in a bent position for a short or prolonged time, and mildly or severely painful.
The great differentiation between the locked finger of trigger finger and Dupuytren contracture is the trigger finger has a very sudden onset and release with a popping sound, and it is apparently normal between episodes. While the stuck finger of Dupuytren contracture is slowly progressive, and does not release because it is constant.
Let’s explore this problem through a few questions commonly asked by people who want to know more about their inability to extend their fingers.
Are the Dupuytren nodules or cords a type of tumor of the hand?
No, Dupuytren’s contracture is not a cancerous tumor, although certain hand problems that also cause hand pain, reduced finger movement and swelling are cancers (giant cell tumor or epitheliod sarcoma). This is the reason it is strongly suggested to have your doctor evaluate your hand complaints and determine a clear diagnosis of the condition that is causing the problem straightening out the fingers and making it so you cannot open your hand without pain.
What keeps my fingers bent all the time and why won’t my fingers straighten out?
Dupuytren contracture begins as a thickening of the deep tissue of the palm (palmar fascia), located below the skin and above the bones and tendons of the palm. This thickened state slowly progresses and the involved tissue also shortens at the same time, gradually allowing less and less movement until the fingers are constricted completely into a modified fist. In the early stage of Dupuytren contracture as the palm lumps develop, it is not possible to flatten the hand on a tabletop and pain accompanies it. Later as cords develop from the nodules, the reduced finger movement makes the stiff fingers more pronounced until they come closer to the palm of the hand.
Is this why my pinky finger and ring finger won’t extend open?
Exactly. People comment that when their Dupuytren contracture starts they can’t open the hand without pain and they experience great clumsiness. Over time this changes to gradually prevent the involved finger so it won’t straighten out completely, sometimes eventually constricting finger movement completely.
Is this the reason I can’t open my hand without pain?
Pain is a common complaint when Dupuytren contracture begins, often described as constant stinging and burning pain wherever there are lumps on the palm of the hand. Over time as each finger gets stuck in a constant bent position, less pain is felt usually.
Generally, Dupuytren contracture is not thought of as a very painful condition; it is known mostly for the bent fingers, inability to fully open the hand, and the palm lumps.