|Overview of Treatments
Physical and Occupational Therapy
Sclero = hardening + dactyly = fingers or toes.
Sclerodactyly = Hardening of fingers or toes.
Systemic sclerosis, such as limited or diffuse scleroderma, sometimes causes sclerodactyly. (Also see What is Sclerodactyly?, Overview of Skin Involvement, What is Scleroderma? and Types of Scleroderma)
Sclerodactyly begins with swollen fingers and/or toes, which are often so swollen that it becomes difficult to bend them. This phase is then sometimes followed by skin thickening, and then skin hardening. It can eventually lead to hands that are stiffened into a claw, and immovable.
It is very important to have treatment and physical therapy starting in the initial stages, before the hands have hardened. Preventing and treating attacks of Raynaud's promptly might lessen the progression of the disease.
Mixed results have been reported for the use of UVA1 phototherapy for sclerodactyly.
For UVA1 treatment, first contact your scleroderma expert to see if it they will recommend it for you. If they recommend and prescribe it for you, try to find UVA1 facilities near you. Some dermatology offices (usually large offices or with major health centers) have UVA1 equipment (not UVB). It may also be possible to buy UVA1 phototherapy equipment for home use. It is manufactured by Daavlin and distributed worldwide. Home users must be monitored by a physician, who will prescribe the necessary dosage and monitor for possible side-effects, such as skin cancer.
Physical therapists can use stretching exercises, warming techniques such as hot wax machines, and form casts to wear (especially at night) so that if the hands do harden, they are molded into the most usable shape for daily activities.
Physical and occupational therapists can also help the patient adjust by identifying adaptive devices and lifestyle changes to help counter some of the effects of this disability. Common hand exercises for arthritis may help some patients. (Remember that scleroderma is a type of arthritis.)
For information about physical therapy, along with books, tapes and other resources to deal with sclerodactyly, see Skeletal Involvement: Joints and Muscles by ISN.
Slide show: Hand exercises for people with arthritis. Arthritis. MayoClinic.
Hand Exercises for Rheumatoid Arthritis. 7 hand-stretching exercises to ease rheumatoid arthritis symptoms. Denise Mann. WebMD.
Surgery of the hand in patients with systemic sclerosis: outcomes and considerations. The goals of surgery for advanced SSc affecting the hand are limited and include pain relief through sympathectomy and increased perfusion, repositioning the digit, providing a functional position of fusion, and modest mobilization through resection arthroplasty. J Rheumatol. (Also see Skeletal Involvement, Raynaud's Treatments, and Calcinosis)
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