Dupuytren contracture surgery — rehabilitation after limited fasciectomy

Record the operated fingers, extent of excision and any additional procedures. Measure active and passive extension and flexion at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints; use the same method for serial measurements. Assess swelling, skin, sensation and tasks important to the patient. Test grip strength only when resistance is permitted. An unexplained difference between active and passive restriction calls for assessment of its cause, not an automatic increase in stretching force.

Do not routinely prescribe a night orthosis for every patient after fasciectomy [1,2]. Consider one for a progressive extension deficit, capsular flexion contracture or after arthrolysis. Position and low corrective force should be selected by the treating team. When an orthosis is indicated, the guideline describes night use for 6–24 weeks with regular review and adjustment [1]; this is not a compulsory duration for every patient. New pain, sensory disturbance, skin irritation or changes in finger colour require a fit check. Do not independently increase the extension force or modify a prescribed orthosis without agreement.

01 · First days: protection and assessment

From surgery until a safe movement programme is established

Goal: Limit swelling, protect the skin and identify restrictions arising from surgery.

Actions: Support the forearm comfortably and elevate the hand intermittently. Review the operative record, circulation, sensation, pain and swelling. Agree the permitted movement and any orthosis with the orthopaedic surgeon; move unrestricted joints of the limb.

Exercises: Do not independently start passive straightening of the operated fingers. Arrange early hand therapy; the guideline favours starting exercises on days 3–5 if local tissue condition and instructions permit [1].

Protection: No forceful gripping, weight-bearing through the hand or forced extension. A skin graft or additional reconstruction rules out automatic use of this schedule.

Progression and review: Progress when restrictions are clear, local tissue condition is stable and movement has been permitted. New sensory loss, increasing pain or a change in finger colour requires assessment, not forceful exercise.

02 · Early finger movement

Usually from days 3–5 to about week 2; once movement is permitted

Goal: Maintain the extension achieved and gradually recover flexion without overloading the skin.

Actions: Use short, gentle movement sessions. The guideline suggests 3–6 sessions daily [1]; tailor their duration and exercise selection to the hand’s response. Check pain, swelling and movement quality after each session.

Exercises: A · Support the forearm and keep the wrist comfortable. Slowly open the hand to the permitted extension, then bend the fingers into a loose partial fist. Do not push with the other hand. Example starting dose: 5 slow repetitions; reduce the range or number if skin tension or pain increases.

Protection: Do not force the fingertips to touch the palm or press the whole hand flat on a table. Avoid sudden stretching and resistance. Passive movement requires individual instruction first.

Progression and review: Progress when movement does not impair healing, symptoms return to baseline after sessions and the extension deficit is not increasing. Deterioration persisting into the next day calls for dose reduction and reassessment.

Approximately weeks 2–6; according to healing and tolerance

Goal: Improve independent finger joint movement and light grip during everyday activities.

Actions: Continue exercise A. Introduce short tasks such as moving light objects and fastening buttons. Gentle scar mobilisation may begin after complete skin closure and instruction; do not perform it over an unhealed surface.

Exercises: B · From straight fingers, bend the interphalangeal joints while keeping the knuckles at the finger bases as straight as comfortable: this forms a hook position. Return to permitted extension. Support the forearm and keep the wrist relaxed. Example: 5 cycles without resistance in selected movement sessions, if the therapist permits this position.

Protection: Select passive stretching and intrinsic muscle exercises after examination; do not add strong pressure. Avoid prolonged forceful gripping and rubbing a sensitive scar.

Progression and review: Before strengthening: completely closed skin, tolerance of light tasks, stable movement and no increasing pain or swelling. If extension is being lost, assess the cause and whether an orthosis is indicated.

Often around weeks 4–6 or later; only after meeting the criteria

Goal: Rebuild grip tolerance without aggravating the tissue response.

Actions: Once resistance is permitted, begin with a soft sponge and brief light tasks. Maintain movement exercises. This stage is not a mandatory date for starting forceful hand exercise.

Exercises: C · Support the forearm. Gently squeeze a soft sponge, then fully relax the grip. Do not squeeze maximally or hold your breath. Suggested starting dose: 5 repetitions, 2–3 sessions per week with a rest day between them.

Protection: Increase one variable at a time: repetitions, task duration or resistance. Do not immediately add heavy tools, forceful twisting or body-weight support.

Progression and review: Progress when the next session and following day bring no increased swelling, pain or loss of movement. If symptoms worsen, return to the previously tolerated dose and seek advice for persistent symptoms.

Usually weeks 6–12 and beyond; according to activity demands

Goal: Recover the dexterity required and maintain the functional result.

Actions: Grade work, recreation and task practice. Example: start with 2–5 minutes of a light task, then pause to assess the hand. Set duration and resistance separately; heavy manual work requires assessment of grip, skin, sensation and safety.

Exercises: Continue the movement exercises still needed. The guideline describes a usual 3–12 weeks of therapy; stopping depends on scar stability and resolution of relevant functional and activity limitations [1], not the calendar alone.

Protection: Resume driving only with a reliable grip, steering control and the ability to respond safely in an emergency, without the effects of medicines that impair performance. There is no single date for every patient.

Progression and review: Persistent or increasing contracture, hypersensitivity and declining daily function require review. Not every loss of extension represents disease recurrence; do not decide this without examination.