What is the recommended rehabilitation protocol for an adult patient with no significant comorbidities after undergoing Dupuytren contracture release?

Rehabilitation After Dupuytren Contracture Release

Start hand therapy immediately upon removal of the operative dressing with active mobilization exercises, and do NOT routinely use night extension orthoses as they provide no additional benefit over hand therapy alone.

Immediate Postoperative Phase (First Week)

• Begin hand therapy at the first postoperative visit when the operative dressing is removed, initiating active mobilization exercises immediately 1
• Apply cryotherapy during the first postoperative week to reduce pain and swelling, as it is inexpensive, easy to use, and has high patient satisfaction 2
• Cryotherapy benefits are most pronounced in the first 3 postoperative days for pain medication reduction and swelling control 2
• Educate patients on safe ice application to avoid cold injury 2
• Monitor closely for early detection of wound healing disturbances, as this is a critical component of postoperative management 1

Early Rehabilitation Phase (Weeks 1-4)

• See patients routinely at weekly intervals to ensure recovery of motion is progressing appropriately 1
• Focus on five key management priorities: early complication detection, edema control, scar management, maintenance of surgical correction, and restoration of finger flexion to preoperative range 1
• Implement active range of motion exercises as the primary intervention, with the program being flexible and individualized based on patient response 1
• Do NOT routinely provide night extension orthoses, as randomized controlled trial evidence shows no statistically significant difference in total active extension, total active flexion, grip strength, or hand function compared to hand therapy alone 3
• Night extension orthoses are associated with a 2.83-fold increased failure rate and lower quality of life scores in tendon repairs, suggesting potential harm 2, 4

Intermediate Phase (Weeks 4-12)

• Continue weekly monitoring and progression of active mobilization exercises 1
• Maintain aggressive edema control and scar management throughout this phase 1
• Progress exercises based on patient tolerance and tissue response, recognizing that reactions to surgery vary widely 1
• Reserve night extension orthoses only for cases where extension loss occurs after surgery, not as routine prophylaxis 3

Critical Rehabilitation Principles

The postoperative program must be flexible—more so than in most areas of hand surgery—because patients demonstrate a wide range of reactions to surgical release 1

Key Management Priorities (in order):

1. Early detection of postoperative complications including wound healing disturbances 1
2. Edema control throughout the rehabilitation period 1
3. Scar management to prevent adhesions and maintain tissue mobility 1
4. Maintenance of surgical correction through appropriate exercise 1
5. Restoration of finger flexion to the degree of preoperative range of motion 1

Common Pitfalls to Avoid

• Do NOT routinely prescribe night extension orthoses for all patients, as evidence shows no benefit over hand therapy alone and potential for harm 3, 2
• Do NOT delay initiation of hand therapy beyond removal of the operative dressing 1
• Do NOT use a rigid, inflexible protocol—the management plan must adapt to individual patient responses 1
• Do NOT neglect weekly follow-up during the critical first 12 weeks, as this monitoring is essential for optimal outcomes 1

Expected Outcomes and Recurrence

• Only 62% of little fingers maintain or improve total active extension between the first postoperative measure and 3 months after surgery, indicating the challenging nature of this condition 3
• The little finger requires special attention during both surgery and rehabilitation, as it does not necessarily benefit from good results and can be particularly delicate and difficult to manage 5
• Recurrence rates of approximately 25% can be expected, with pre-treatment contracture ≥25° being predictive of recurrence 6
• Patient education regarding realistic expectations and the potential for recurrence is essential for optimal adherence to treatment 5

Therapist Qualifications

The effectiveness of the postoperative program depends significantly on the therapist's education and experience with Dupuytren's disease 1. Hand therapists should have specific training in managing the unique challenges of this condition, particularly the wide variability in patient responses and the delicate balance between maintaining extension and restoring flexion 1.