Dupuytren’s contracture is a condition that affects the hands and fingers, caused by the thickening of tissue below the skin. It leads to an irregular pulling of the fingers toward the palm, which can make it difficult or impossible to straighten them. Although Dupuytren’s contracture is more common in men over 50, people of any age and gender can be affected.
The exact cause of Dupuytren’s contracture is not known, although it often runs in families and may be linked to diabetes, alcoholism or other factors. Treatment options for Dupuytren’s contracture include observation, splinting, needle release and surgery. The goal of treatment is to reduce the severity of the contracture, improve hand function and reduce pain. Early detection and treatment are key to achieving these goals.
History and Definition
Dupuytren’s contracture, also known as Dupuytren’s disease, is a condition that affects the hands, causing one or more fingers to bend towards the palm and become stiff, making it difficult to straighten them. The condition is caused by thickened and contracted connective tissue, typically in the palms, and is most common in middle-aged and elderly men of northern European descent.
The disease is named after Baron Guillaume Dupuytren, a French surgeon who first described it in the early 19th century. However, the condition has been present for centuries before that. Tradition has it that the disease originated with the Vikings, who spread it throughout Northern Europe and beyond as they travelled and intermarried. Dupuytren’s contracture was first described in the medical literature in the 16th century.
Dupuytren’s contracture is a progressive disorder that typically begins with small, painless nodules in the palm. Over time, these nodules can develop into thickened cords of tissue that can pull the fingers into a bent position. The condition can vary in severity, with some people experiencing only mild symptoms, while others may have difficulty performing everyday tasks such as buttoning a shirt or shaking hands.
Symptoms
The symptoms of Dupuytren’s contracture can vary in severity, but common symptoms may include:
- Difficulty in laying your hand flat on a table, palm down (called the tabletop test)
- The presence of one or more small, tender lumps (nodules) in the palm. Over time, the tenderness usually goes away.
- The nodules may thicken and contract or tighten, forming thick bands of tissue under the skin of the palm.
- Pits or grooves in the skin compressed by the contracted finger. These areas can become very sore and can lead to skin loss if they don’t heal properly.
- Fingers are being pulled forward, resulting in difficulty in working with the hand.
Dupuytren’s contracture symptoms may resemble those of other conditions or medical problems. Therefore, it is important to see a healthcare provider for a proper diagnosis.
Causes
The exact cause of Dupuytren’s contracture is not known, but it is believed to run in families (be hereditary).
Several risk factors have been identified that may contribute to the development of Dupuytren’s contracture. These include:
- Age: The condition is most commonly seen in middle-aged and elderly individuals.
- Gender: Dupuytren’s contracture is more common in men than women.
- Ethnicity: It is most commonly seen in people of northern European descent.
- Hereditary: There seems to be a genetic component to the disease, as it is more common in people with a family history of the condition.
Other factors that may contribute to the development of Dupuytren’s contracture include:
- Cigarette smoking
- Alcoholism
- Diabetes
- Nutritional deficiencies
- Medications used to treat seizures
It is not entirely clear how these factors may contribute to the development of Dupuytren’s contracture, but research suggests that they may play a role in the disease process.
Diagnosis
Diagnosis of Dupuytren’s contracture requires a thorough physical examination of the affected area, including palpation and range of motion assessment. A doctor may also order imaging tests such as ultrasound or MRI to confirm the diagnosis. Treatment for Dupuytren’s contracture typically includes medication, physical therapy and/or surgery, depending on the severity of the condition. Early diagnosis and intervention are important to prevent further tissue damage and deterioration.
Treatment
Treatment options for Dupuytren’s contracture include:
Non-Surgical
- Splinting: A splint can be used to hold the affected finger(s) in a straight position to help prevent further contracture.
- Physical therapy: Exercises to stretch and strengthen the affected fingers and hand can help to improve function and reduce pain.
- Needle aponeurotomy: This is a minimally invasive procedure where a needle is used to break up the thickened fascia in the palm. This procedure can be performed in an outpatient setting and it can improve the range of motion in some cases.
Surgical
- Fasciectomy: This procedure involves removing the thickened fascia through an incision in the palm. It is a more invasive procedure and requires general or regional anesthesia.
- Dermofasciectomy: This procedure is similar to fasciectomy but it also includes removing the skin overlying the fascia. This procedure is typically reserved for cases where the skin is also involved in the contracture.
- Minimally invasive surgery: There are also less invasive surgical methods such as collagenase Clostridium histolyticum (CCH) injection such as Xiaflex, which is a non-surgical alternative to traditional open fasciectomy.
After the surgery, the patient will be placed in a splint to keep the fingers in the correct position while healing, which can take several weeks. Physical therapy and hand therapy will be prescribed to help regain the range of motion and strength of the hand and fingers.
It is important to note that while surgery can improve the range of motion and reduce contracture, it may not completely restore normal function and it may not prevent the recurrence of the condition.
The recovery time for Dupuytren’s contracture surgery varies depending on the type of procedure performed and the patient’s overall health. In general, patients can expect to experience some pain and swelling in the affected hand following the surgery, which can be managed with pain medication.
The patient will also need to keep the hand elevated to reduce swelling and keep the incision clean. It is also important to follow the physical therapy and hand therapy program recommended by the surgeon to achieve the best outcome.
Risk Factors
Several risk factors have been associated with Dupuytren’s contracture:
- Age: The condition is most commonly diagnosed in people over the age of 50.
- Gender: Dupuytren’s contracture is more common in men than in women.
- Genetics: The condition tends to run in families, and people with a family history of Dupuytren’s contracture are at a higher risk of developing the condition.
- Ethnicity: Dupuytren’s contracture is more common in people of Northern European descent.
- Medical conditions: People with diabetes, epilepsy, and alcoholism are at a higher risk of developing Dupuytren’s contracture.
- Occupation: People whose work involves repetitive hand motions, such as manual labor or playing certain musical instruments, are at a higher risk of developing Dupuytren’s contracture.
- Smoking: smokers are at a higher risk of developing Dupuytren’s contracture.
- Trauma: People who have had a hand or finger injury, or have had surgery on the hand, are at a higher risk of developing Dupuytren’s contracture.
It’s worth noting that having one or more risk factors does not necessarily mean that a person will develop Dupuytren’s contracture. And many people who have the condition may not have any known risk factors.
Complications
Dupuytren’s contracture can lead to several complications, including:
- Loss of function: The inability to fully straighten the affected fingers can make it difficult to perform daily activities such as grasping objects or shaking hands.
- Pain: Some people with Dupuytren’s contracture may experience pain or discomfort in the affected fingers or palms.
- Stiffness: The affected fingers can become stiff, making it difficult to move them freely.
- Recurrence: Dupuytren’s contracture can recur after treatment, requiring additional surgery.
- Nerve damage: In some cases, the condition can compress the nerves in the hand, causing numbness or tingling in the affected fingers.
- Development of skin ulcers: In some cases, skin ulcers can develop on the fingertips as a result of pressure on the skin by the contracting tissue.
- Difficulty in performing activities of daily living: When contracture affects the fingers of the dominant hand, it can make it difficult to do simple things like buttoning a shirt, holding a pen, or opening a jar.
- Psychological distress: Some people with Dupuytren’s contracture may experience emotional or psychological distress related to their condition, such as feelings of self-consciousness or embarrassment.
It’s worth noting that not all people with Dupuytren’s contracture will experience these complications, and the severity of the condition can vary widely. In some cases, the condition can progress slowly, and people may not experience significant complications.
When to See a Doctor
It is a good idea to see a doctor if you have symptoms of Dupuytren’s contracture, such as:
- A thickening or nodularity in the palm of your hand
- Pain or discomfort in the affected area
- Inability to fully straighten one or more fingers
- Difficulty in performing activities of daily living such as grasping objects or shaking hands.
If you have any of the above symptoms, it is important to see a doctor, especially if the symptoms are affecting your ability to perform your daily activities. A doctor will be able to diagnose the condition and recommend the best course of treatment based on the severity of the condition.
It is also important to see a doctor if you have any of the following:
- Numbness or tingling in the affected fingers
- Development of skin ulcers on the fingertips
- Loss of function in the affected hand
- If your symptoms are severe or progressing rapidly, it is important to seek medical attention as soon as possible.
The early diagnosis and treatment of Dupuytren’s contracture can help prevent the condition from progressing and reduce the risk of complications.
Step-by-Step Guide to Dupuytren's Contracture Treatment
A step-by-step guide to Dupuytren’s contracture treatment may include the following:
Consultation
The first step in the treatment of Dupuytren’s contracture is to schedule a consultation with a hand surgeon or a specialist in hand surgery. During the consultation, the doctor will perform a physical examination and take a medical history to determine the severity of the condition and the best course of treatment.
Imaging Tests
The doctor may also order imaging tests such as X-rays or MRIs to confirm the diagnosis and determine the extent of the contracture.
Nonsurgical Treatment
If the contracture is mild, the doctor may recommend non-surgical treatment options such as splinting, physical therapy, or needle aponeurotomy.
Surgical Treatment
If the contracture is more severe or non-surgical treatments have not been successful, the doctor may recommend surgery. The type of surgery will depend on the extent of the contracture, the patient’s overall health, and the patient’s preferences.
Pre-Surgery Preparation
Before the surgery, the patient will need to undergo a pre-surgery evaluation which may include blood tests, ECG, and other tests to ensure the patient is fit for the procedure.
Surgery
The surgery is typically performed under general or regional anesthesia. The patient will need to stay in the hospital for a few days to recover.
Post-Surgery Recovery
After the surgery, the patient will be placed in a splint to keep the fingers in the correct position while healing. Physical therapy and hand therapy will be prescribed to help regain the range of motion and strength of the hand and fingers.
Follow-Up Appointments
The patient will need to attend follow-up appointments with the surgeon to monitor the recovery and progress.
Conclusion
In conclusion, Dupuytren’s contracture is a progressive condition that affects the hands and fingers, causing thickened tissue to form cords that make it difficult for the affected area to move. It is caused by a variety of factors and can lead to permanent disability if left untreated.
Treatment options vary depending on the severity of the disease and include nonsurgical and surgical procedures. Early diagnosis and treatment are essential to minimize the effects of Dupuytren’s contracture. With proper management, people with this condition can lead a normal life.
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