Dupuytren’s Contracture can be defined as a deformity that results in thickening of the fascia, a thin elastic tissue under the skin of the palm. The fibrous cords in this tissue develop knots, causing the fingers to bend downwards. In most cases, it is the little and ring finger that gets bent towards the palm. Dupuytren’s Contracture is a progressive disorder that may affect one or both the hands and the symptoms tend to aggravate over the time.
Other Names
- Dupuytren’s Disease
- Palmar Fibromatosis
- Morbus Dupuytren
- Viking disease
- Celtic hand
- Contraction of the palmar fascia
- Palmar fascial fibromatosis
- Palmar fibromas
Causes
- Dupuytren’s Contracture is categorized as an idiopathic disorder as the exact cause has not been not clearly identified. However, the following factors may increase an individual’s susceptibility to the condition:
- It could be a genetic trait that
- affects members of the same family
- Men above the age of 50 years are more likely to develop the condition
- Alcohol consumption and smoking are believed to cause changes in the blood vessels that may lead to skin contractures
- Diabetic people are at a greater risk
Symptoms
- Routine activities such as wearing gloves, and shaking hands may become difficult
- Visibly deformed fingers as they tend to bend towards the palm
- The lumps of tissues may be visible in the hand and are sensitive when touched
- Pain may or may not be experienced
- Reduced flexibility of the hands and fingers
- The deformity begins with the thickening of the skin of the palm and as it progresses, the palm may appear puckered due to thick knots
- Inability to straighten the hand or grasp objects
- Some patients may develop knots on their knuckles as well as soles of the feet
The signs of Dupuytren’s disease show up in phases:
- Nodules: These lumps under the skin in the palm of the hand are the first symptoms for many people. The lump may feel tender and sore at first, but this discomfort eventually goes away.
- Cords: The nodules cause these tough bands of tissue to form under the skin of the palm. These inflexible bands cause the fingers to bend, or “curl,” forward toward the wrist.
- Contracture: As the curling gets worse, it becomes difficult, if not impossible, to straighten the fingers. People with Dupuytren’s disease often have a hard time picking up large objects or placing their hands into their pockets, something you might do every day to retrieve coins, cash, or your ID card. If you have this condition, you may also find it difficult to place your hand flat on the table, wear gloves, or shake hands, among other things.
Diagnosis
- Details of the patient’s family history, medical history, and lifestyle may be noted
- The orthopedic doctor may perform a physical evaluation of the hand which includes a comparison of both the hands to identify the symptoms and palpation to detect knots or lumps under the skin
- Tabletop test- The patient may be asked to place his hand flat on the table. Inability to do so confirms the presence of Dupuytren’s Contracture
Treatment
Treatment is aimed at ceasing the progression of the condition and enabling the patient to cope up with the symptoms. These may include:
- The needling technique may be used to puncture the thick tissue cords in the palm. It can be used to pierce more than one finger at the same time as no incision is made
- Splinting may be helpful in straightening the fingers in case of mild contractures
- Surgical release or cutting of the affected tissue that causes bending of the fingers
- Enzymes may be injected into the affected part of the palm to weaken the hard lumps and cords. The fingers are then manipulated to bring them back into their normal position and improve flexibility
- In severe cases, all the tissues from the hand may be surgically removed followed by a skin graft to allow reconstruction of the palm.
- Physical therapy may be recommended post-surgery
- Wearing padded gloves while lifting weights or grasping objects may be helpful
- Steroid shot (injection). If a lump is painful, a steroid injection may help ease the pain. In some cases, it may stop your condition from getting worse. You may need repeated injections.
- Radiation therapy. This treatment is not as common in the U.S. Low energy X-rays are directed at the nodules. This works best in the early stage of the disease. It can soften the nodules and help keep contractions from happening.
- Enzyme injection. This is a newer, less invasive procedure done by specially trained surgeons. Your doctor injects a medicine into the area to numb the hand. Then the enzyme is injected into the lump of tissue. Over several hours, the enzyme breaks down and dissolves the tough bands. This lets the fingers straighten when the cord is snapped by the surgeon, usually the next day.
- Needle aponeurotomy. This is another newer, less invasive procedure. Medicine is injected into the area to numb the hand. The surgeon uses a needle to divide the diseased tissue. No incision is made.
Surgical treatment
If the condition continues to get worse despite medications and your hand function is severely limited, your doctor may recommend surgery. The two most common types are:
- Fasciotomy: This procedure divides the thick cord of ligament tissue so the affected finger can move more freely. Your doctor numbs the area and makes a small cut in your palm near the affected finger. You’ll need to wear a splint while the area heals.
- Subtotal palmar fasciectomy: With this procedure, your doctor removes as much of the cord and tissue as they can so your finger can straighten out. They’ll probably make a “zig-zag” cut in your hand to reach the affected area. This is a more complicated type of surgery than a fasciotomy, so there’s more involved in recovery, including careful care of the area and possibly physical therapy and a skin graft (when healthy skin is taken from another part of your body to seal the wound).
