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Dupuytren's contracture is a type of hand deformity that often develops over time. The illness damages a layer of tissue beneath your palm's skin. Tissue knots accumulate beneath the skin, eventually forming a strong string that can pull one or more fingers into a bent posture.
The affected fingers cannot be entirely straightened, making routine activities such as putting your hands in your pockets, putting on gloves, or shaking hands more difficult.
Dupuytren's contracture primarily affects the two fingers farthest from the thumb and is more common in older males of Northern European ancestry. There are several treatments available to decrease the advancement of Dupuytren's contracture and alleviate symptoms.
WHAT ARE THE SYMPTOMS OF DUPUYTREN'S CONTRACTURE?
Dupuytren's contracture usually advances slowly and over time. The ailment usually starts with a thickening of the skin on your palm. As time goes on, the skin on your palm may get puckered or dimpled. On your palm, a solid lump of tissue can form. This bump may be sensitive to touch, but it is usually not unpleasant.
Cords of tissue form under the skin on your palm in the later stages of Dupuytren's contracture and can extend up to your fingers. As these cables tighten, your fingers may be dragged painfully toward your palm.
The two fingers furthest from the thumb are the most usually impacted, while the middle finger can also be affected. Thumb and index finger are rather infrequently affected. Dupuytren's contracture can affect both hands, albeit one hand is usually more seriously afflicted.
WHAT ARE THE CAUSES OF DUPUYTREN'S CONTRACTURE?
Doctors are baffled as to what causes Dupuytren's contracture. There is no evidence that hand injuries or activities involving hand vibrations cause the syndrome.
WHAT ARE THE RISK FACTORS FOR DUPUYTREN'S CONTRACTURE?
Several variables are thought to raise your risk of the condition, including:
- Age: Dupuytren's contracture most usually arises after the age of 50.
- Sex: Men are more prone than women to develop Dupuytren's and have more severe contractures.
- Ancestry: People of Northern European ancestry are at a higher risk of contracting the disease.
- Family history: Dupuytren's contracture is frequently inherited.
- Tobacco and alcohol consumption: Tobacco usage is linked to an increased risk of Dupuytren's contracture, possibly due to microscopic alterations within blood vessels caused by smoking. Alcohol consumption is also linked to Dupuytren's disease.
- Diabetes: Diabetes has been linked to an increased risk of Dupuytren's contracture.
WHAT ARE THE COMPLICATIONS OF DUPUYTREN'S CONTRACTURE?
Dupuytren's contracture might make it difficult to execute some hand functions. Because the thumb and index finger are rarely damaged, many persons have little difficulty or handicap with fine motor activities such as writing. However, if Dupuytren's contracture worsens, it might make it difficult to fully open your hand, grab large things, or get your hand into tight spaces.
HOW IS DUPUYTREN'S CONTRACTURE DIAGNOSED?
Doctors can usually identify Dupuytren's contracture based on the appearance and feel of your hands. Other tests are rarely required.
Your doctor will examine your hands and look for puckering on the skin of your palms. He or she will also press on different sections of your hands and fingers to look for hardened knots or tissue bands.
Your doctor may also ask whether you can place your hand flat on a tabletop or other flat surface. If you can't totally flatten your fingers, you have Dupuytren's contracture.
WHAT ARE THE TREATMENTS FOR DUPUYTREN'S CONTRACTURE?
If the condition proceeds slowly, causes no pain, and has no influence on your ability to perform daily duties with your hands, you may not require therapy. You can instead wait to see if Dupuytren's contracture progresses. You might choose to continue the development with a tabletop test that you can do on your own.
The cords that are dragging your fingers toward your palm must be removed or broken apart as part of the treatment. This can be accomplished in a variety of ways. The technique you choose is determined on the severity of your symptoms and any other health issues you may have.
Needling
A needle is placed through your skin to pierce and break the cord of tissue that is compressing a finger. Contractures frequently reoccur, although the procedure is repeatable.
The key benefits of the needling procedure are that there is no incision, it may be done on multiple fingers at once, and it usually requires very little physical rehabilitation afterward. The biggest downside is that it cannot be utilized in some areas of the finger because it may cause nerve or tendon damage.
Enzyme injections
Injecting an enzyme into the taut cord in your palm can soften and weaken it, allowing your doctor to maneuver your hand later to break the cord and straighten your fingers. Clostridium histolyticum collagenase (Xiaflex) has been approved by the FDA for this purpose. The benefits and drawbacks of enzyme injection are comparable to those of needling. Enzyme injections are not available at all medical facilities.
Surgery
Another option for persons with advanced disease, limited function, and progressing disease is to surgically remove the diseased tissue in your palm. The fundamental advantage of surgery is that it provides a more comprehensive and longer-lasting release than needle or enzyme techniques. The main disadvantages are that physical therapy is frequently required following surgery, and recovery time can be extended.
Surgeons remove any tissue likely to be impacted by Dupuytren's contracture, including the associated skin, in severe cases, especially if surgery has failed to treat the problem. A skin graft is required in these circumstances to cover the exposed wound. This procedure is the most intrusive and requires the most time to recover from. Following surgery, most people require months of intensive physical rehabilitation.