Index
It refers to fibrosis in the palmar fascia of unknown origin.
Dupuytren’s disease, also called Dupuytren’s contracture, is an abnormal thickening of the skin on the palm of the hand at the base of the fingers, known as fascia.
This thickening can develop into a hard lump or a thick band.
Firm pits, nodules, and cords can develop that can cause the fingers to bend toward the palm, in which case it is described as Dupuytren’s contracture.
Dupuytren’s contracture usually progresses slowly and may remain mild.
For moderate or severe cases, the condition can interfere with hand function.
When this occurs, non-surgical and surgical treatment options can restore normal movement to the affected fingers.
A prominent French physician by the name of Guillaume Dupuytren described the disease in 1837, hence its name.
Causes of Dupuytren’s disease
The cause of Dupuytren’s disease is unknown, but it may be associated with certain biochemical factors within the involved fascia.
However, some things can increase your risk, such as:
- Sex: This condition is much more common in people over 40 and more severe in males than in females.
- Medications: taking certain medications such as antiepileptics.
- Genetics – A parent or other close relative who has had this condition.
- Ethnicity: People of Northern European or Scandinavian descent are at higher risk of contracting the disease. Dupuytren’s disease is sometimes called the curse of the Vikings, and it is prevalent in those descendants of Scandinavians and Celtic races such as the Scots. It is much less common in South Americans, Indians, and those from the Middle East.
- Diseases: Certain medical conditions, such as diabetes, high cholesterol, and thyroid problems increase the risk of developing the disease.
- Substance abuse: such as alcohol abuse and smoking.
Conditions related to Dupuytren’s disease
People who have Dupuytren are also at higher risk for joint-related conditions in other areas of their bodies.
Similar conditions that can occur along with Dupuytren’s contracture include:
Stenosing tenosynovitis
More commonly called the trigger finger, this is a disorder in the tendons that connect the muscles of the forearm to the fingers.
People with trigger digits have tendons that stick, causing the fingers to stay in a locked position and “click” when straightened.
Carpal tunnel syndrome
Carpal tunnel syndrome is a weakness in the thumb, forefinger, and forefinger, which can be caused by repetitive stress and other factors.
Signs and symptoms of Dupuytren’s disease
Symptoms usually include lumps and pitting on the palm. Symptoms often progress gradually over many years and these can include:
- Decreased function of the hand.
- Not being able to put the palm of the hand on a flat surface.
- Nodules or small lumps in the palm of the hand that are initially tender.
- Pits or grooves in the skin.
- Thick cords of tissue under the skin that pull the fingers inward.
- Dupuytren’s disease can affect any finger on the hand, most often this affects the ring finger and the little finger and can affect one or both hands.
There may be no pain associated with the hardening of the tissue, but sometimes the tissue can become inflamed and cause pain, burning, or itching in the joints.
When you have Dupuytren’s contracture, you may have trouble doing everyday tasks, like writing, cooking, or tying your shoes.
Diagnosis of Dupuytren’s disease
The physical exam includes measuring the range of motion and sensation in the fingers and thumb, and recording the location of nodules and chords.
These measurements will be compared with subsequent measurements to assess disease progression.
Treatment of Dupuytren’s disease
In mild cases, the function of the hand is not affected. For more severe cases, several treatment options are available to straighten the finger.
These options may include collagenase injection, needle aponeurotomy, or open surgery.
Non-surgical treatment
If diagnosed early, the symptoms of Dupuytren’s disease can be reduced without surgery. Non-surgical treatments include:
Enzyme injection
It is a minimally invasive procedure that is performed on an outpatient basis and involves injecting an enzyme solution into the hand.
Over several hours or days, the enzyme breaks down, dissolves, and weakens the contracted tissue, so that the finger can be manipulated manually to make it straighter.
Needle aponeurotomy
It involves passing the sharp end of a hypodermic needle back and forth through restrictive cords to weaken and divide diseased tissue.
Needle aponeurotomy is used to cut Dupuytren tissue. Both collagenase injection and needle aponeurotomy are outpatient procedures.
Surgical treatment
If nonsurgical treatment does not relieve your symptoms, surgery may be recommended. Surgical approaches include:
The fasciotomy
It consists of making an incision in the palm of the hand through which the surgeon divides the thickened tissue.
Dividing the cord helps decrease contracture and increase finger movement.
Subtotal palmar fasciectomy
This involves a zigzag incision along the folds of the hand through which all abnormal tissue and the cord are removed to stretch the fingers.
Occasionally, a skin graft may be necessary to help the wound heal.
If surgery is necessary for recurrent disease, skin grafts are taken frequently to act as protection against disease progression.
Further work with manual therapists is necessary to obtain the best results.
The biggest hurdle after surgery is regaining full flexion of the fingers, and it takes a lot of work to do this.
Complications can occur as a result of surgery
- Fingers may become stiff, lacking flexion.
- The disease may recur and begin to cause gradual flexing of the fingers towards the palm again.
- Infections, bruising (accumulation of blood), and problems with skin grafts can occur, as well as damage to the blood vessels and nerves in the fingers.
- A rare but serious complication is when the hand becomes stiff, swollen, and painful, but this is necessary, despite these potentially alarming problems from surgery.
Prevention
While Dupuytren’s disease cannot be prevented, being aware of the risk factors and monitoring the health of your hands can help you find and treat the disease early.
