What Is Dupuytren’s Contracture?
Dupuytren’s contracture is a condition where there is a thickening and tightening of the fascia of the palms and fingers. The fascia in hand lies beneath the skin and functions to anchor and stabilize the skin over the palms of the hand. Without the fascia, the skin of the palm would become very loose. In Dupuytren’s contracture, the scarring accumulates in a tissue that normally covers the tendons that pull the fingers to grip. This hand deformity develops over the years. As a Dupuytren's contracture begins to progress, more of the fascia becomes very thickened due to the formation of knots of tissue under the skin. This leads to a shortening of the fascia. This condition mainly affects the fingers which are far away from the thumb. This might include the fourth and fifth fingers, most commonly. Even after complete treatment, in severe cases, the fingers cannot be brought back to the normal form completely.
Whom Does It Affect?
-
It is known to affect the people of Northeastern origin.
-
Men are most commonly affected than women.
-
Dupuytren's contracture is known to occur more frequently in patients with diabetes mellitus.
-
Alcoholic patients are most commonly affected.
-
It is known to occur in patients who are more than 50 years of age.
What Are the Symptoms?
The condition begins as a thickening on the palms of your hand. As the condition progresses, the skin on your palm might appear contracted or dimpled. A firm lump of tissue begins to form on the palm. This lump of tissue might be very sensitive to the touch, but it is not usually painful. During the later stages of Dupuytren's contracture, the cords of tissue begin to form under the skin. This results in the formation of knots on your palm. This can extend up to your fingers and tips. Dupuytren's contracture can make it difficult for the individual to perform certain activities using your hand. There may be many difficulties in performing day to day activities. Since the thumb and index finger are not usually affected, most people do not have inconvenience or disability with fine motor functions such as writing and holding light objects. It can restrict the ability to open your hands, grasp large objects, or get your hand into narrow places.
What Are the Characteristics of Dupuytren’s Contracture?
The fingers might get pulled toward your palm further. The last two fingers farthest from the thumb are most commonly affected. Sometimes, the middle finger also can be involved. Rarely it affects the thumb and index finger. Dupuytren's contracture can occur in both hands. One hand is usually affected more severely.
What Are the Causes of Dupuytren’s Contracture?
The exact cause of Dupuytren's contracture is not known.
In a few cases, Dupuytren's contracture can be inherited from the family members, and hence, it is also considered a genetic problem.
How Is It Diagnosed?
It is diagnosed by health care professionals clinically. The doctor will check to see if you can put your hand flat on the top of the table. If you are not able to fully flatten your fingers and palm, this indicates that you have Dupuytren's contracture. It can be confused with few nerve disorders, but careful evaluation and examination make the diagnosis clear.
How Is It Treated?
In order to formulate the treatment, the severity and progression of the disease should be noted. If the condition is slowly progressing, then you need not worry much.
Needling Technique:
In severe cases, you might need this technique. In this technique, the usage of needles does magical treatment. Needles are inserted through your skin and are punctured to break the cord of tissue. Contractures are often known to recur. In such cases, the procedure has to be repeated.
One of the main advantages of the needling technique is that there is no incision. Because of this, needling can be done on several fingers at the same time. The disadvantage is that it cannot be used in some places of the finger where there is a risk of damage to the nerve.
Injection of Enzymes:
Injecting a specific type of enzyme into your palm can soften the tendons. There are chances of weakening of the nerves and tendons in the palm. Clostridial collagenase enzyme is known to be more effective.
Radiation Therapy:
This is the non-invasive procedure. It can be given for patients with little severity. Studies are going on the application of radiation for this condition. However, it has not shown completely positive results.
Surgery:
In most severe cases, the other option for the patient is to surgically remove the tissue in your palm. It gives a permanent cure in a few cases.
Fasciotomy:
In this procedure, local anesthesia will be given to the hands, and the whole body will not be put to sedation. The surgery will be done on the given area, and the wound will be left open.
After the surgery, you will be asked to go on a splint for recovery.
Complications of Surgery:
There are various risks associated with surgery for Dupuytren's contracture. You have to give a second thought before agreeing for the procedure. It is always good to know about the pros and cons of surgery. The important factors to be considered before the surgery are:
-
The severity of the contracture should be considered.
-
The number of contractures to be noted in a single visit.
-
Any other history of medical conditions and illnesses in the patient.
It is ethical for your doctor to discuss the complications in the surgery. The different potential risks after surgery are:
-
Severe pain.
-
Scarring after the surgery. If the patient is very much worried about esthetics, it might be difficult to achieve.
-
Surgical trauma to nerves and blood vessels.
-
Loss of sensation might be felt due to the contraction of palms for a long time.
Prognosis:
The prognosis is not predictable most of the time. But this condition is known to have a high recurrence rate.
For more information about Dupuytren’s contracture, consult a doctor online.
