Dupuytren’s Contracture

What is Dupuytren’s Contracture?

Dupuytren’s Contracture is a disorder in the hand caused by palmar fibromatosis in which the internal structures of the palm to become contracted, uncomfortable pulling one or more fingers in towards the palm and making use of the hand very difficult.

What causes Dupuytren’s Contracture?

Dupuytren’s Contracture may occur as a result of trauma to the palmar fascia. However, most who suffer from it do so as the result of their own genetics. According to studies, the majority of all sufferers of Dupuytren’s Contracture have one or more close relatives who also suffer from it. The exact mechanisms by which it is transmitted genetically are not fully understood, but its connection is undoubted. Men are approximately ten times more likely than women to develop the contracture, and it is also commonly found in people of Northern European descent, which has led to it being called Celtic Hand, or sometimes the Viking Disease.

Symptoms of Dupuytren’s Contracture

The preliminary symptom of Dupuytren’s Contracture is the thickening of the fascia of the palm, which becomes noticeable to touch, and even painful. The disease actually causes the collagen in the tissue to transform from type I to type III, which is a noticeably thicker kind of collagen, and one not usually found in the affected area. After the initial pain of the thickening recedes, the condition will continue without it, which often causes people to delay seeking treatment. Starting most often with the two outermost fingers (the little and ring fingers), the fingers will begin to curl inwards towards the palm, greatly impeding function to the sufferer. In extreme cases, the middle finger may also be affected, but the index and thumb seldom are. In either case, impeded function as a result of contracture should be cause to seek immediate medical attention from a hand specialist.

How can I know if I have Dupuytren’s Contracture?

In the earliest stages of the disease, Dupuytren’s Contracture, can sometimes be mistaken for Trigger Finger, because of the involvement of the flexor tendons and the outward appearance of the injury. It is only though examination of the affected fascia and the associated thickening of palmar tissue that a diagnosis of Dupuytren’s Contracture becomes clear.

Treatment of Dupuytren’s Contracture

Non-Surgical

In the initial stages before a joint contracture develops stretching is done and if pain, NSAIDs may be helpful.

Injected drugs, such as Xiaflex, can be helpful in the treatment of the contracture. They work by softening the connective tissues of the hand, and dissolving the unnaturally thickened fascia, restoring movement and function to the otherwise essentially useless fingers. That being said, these medications are not miracle drugs, and are not always effective, depending on the severity of the contracture. In some cases the injection may lead to complications such as a tendon ruptures.

Surgical

Once a contracture develops in the digit of approximately 30 degrees at the MCP and any degree of contracture at the PIP, surgery is usually indicated. As with many diseases of the hand, surgical treatment of Dupuytren’s Contracture requires the doctor to open up the affected area and remove the abnormal tissue. The thickened fascia is thinned out from the skin using a scalpel and the entirety of the thickened tissue is removed throughout the digit and palm, with care taken to preserve all vital structures. The skin may also be involved, and can be caught up in the thickening of the fascia, so it is possible that the doctor may have to remove or resect some parts of the skin during surgery. Therapy starts within a few days of surgery to make sure joint flexion is maintained while preserving the improved extension. The sutures usually come out 10-14 days after surgery. The total recovery time is approximately 2-3 months. The recurrence rate is approximately 25% over years.

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