Stiffness & Deformities
Stiff joints and deformity of the hand or arm are often the result of abnormal scarring or healing. This can occur in the skin, around the tendons and ligaments, or can result from poor healing and alignment of fractured bones.
Skin Scarring
Skin scarring compromises the distensibility of the skin, thereby tethering and limiting the normal motion of joints. Such tethering can occur as a result of poorly aligned lacerations, or excessive scarring after burns.
Excessive skin scarring can only be corrected by surgical realignment of scars or by excising wide scarred areas and replacing them with skin grafts obtained from other areas of the body
Dupuytren's contracture represents a special type of "skin" contracture. It actually involves a tissue layer just beneath the skin called the palmar fascia. The thickening and shortening of the palmar fascia results in the gradually progressive flexed posturing of the fingers, particularly the ring and little fingers.
When these finger deformities begin to develop, the only recourse is to surgically excise the diseased, thickened portion of the palmar fascia. Poorly planned surgery for Dupuytren's disease can result in nerve damage and significant wound complications.
Tendon Adherence
Tendon scarring eliminates the normal gliding function of the involved tendons. This not only prevents bending the joints in the desired direction, but can also tether a joint and prevent it from being moved in the opposite direction.
For instance, scarring of the tendons that allow the joints in the fingers to be flexed will not only prevent the finger from being bent, but will also prevent it from straightening out completely. Minimal scarring or scarring of short duration can often be overcome with aggressive hand therapy.
When therapy is unsuccessful, surgically releasing the scar tissue about the tendon is often quite useful. In the more severely scarred tendon, restoration of motion may only be accomplished through a two-staged surgical procedure to replace the scarred tendon with a normal smooth tendon obtained from another area of the body.