Dupuytren contracture
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Dupuytren contracture is a condition characterized by the bending of one or more fingers toward the palm of the hand, making it difficult for the affected fingers to fully extend. This condition is marked by the development of knots of tissue beneath the skin, which eventually form a thick cord that can cause the fingers to bend. As time passes, Dupuytren contracture tends to worsen progressively.
Symptoms
Dupuytren contracture is a condition that progresses gradually over time. The initial symptom is the development of a firm lump in the palm of the hand, which may or may not be painful. As the condition advances, this lump can extend into a tough cord beneath the skin and into the finger. This cord often tightens and pulls the affected finger toward the palm. Typically, Dupuytren contracture primarily affects the two fingers farthest from the thumb, and it commonly affects both hands.
Causes
It is uncertain what causes Dupuytren contracture. The illness typically runs in families. Men are more likely than women to have it.
Risk factors
The following are risk factors for Dupuytren contracture:
- Age. The most prevalent age at which Dupuytren contracture arises is after 50.
- Gender. Dupuytren is far more common in men than in women. Men may experience worsening symptoms that worsen faster.
- Race. Individuals with ancestry from Northern Europe are more susceptible to the illness.
- Family history. Oftentimes, Dupuytren contracture runs in families.
- Occupation. Research indicates a link between vibrating tool users and Dupuytren contracture.
- Diabetes. Diabetes increases the chance of Dupuytren contracture.
- Tobacco and alcohol use. The risk of Dupuytren contracture is increased by both alcohol consumption and tobacco use
- Other medical conditions. Having epilepsy and other seizure disorders, alcohol use disorder (also known as alcoholism), HIV and AIDS, or vascular disease.
Diagnosis
In most cases, Dupuytren contracture can be diagnosed by examining the hands, and additional tests are rarely necessary. Doctors typically compare both hands to look for any puckering or dimpling of the skin on the palm. They also use their hands to apply pressure to specific areas of the hands and fingers to check for the presence of hard bands of tissue or knots.
Another method of assessing for Dupuytren contracture involves using a flat surface like a tabletop. If you are unable to fully flatten your fingers on the surface, it may indicate the need for medical evaluation.
Treatment
If Dupuytren contracture progresses slowly, is not painful, and doesn’t significantly impact your ability to perform daily tasks with your hands, you may not require treatment. You may opt for a watchful waiting approach to see if the condition worsens over time. Some individuals choose to monitor their condition using a self-administered tabletop test to assess any changes in their hand function.
However, if your symptoms become more severe, or if you have additional medical concerns, there are several procedures available. These procedures involve removing or disrupting the cords responsible for pulling your fingers towards your palm. The choice of procedure depends on the extent of your symptoms and any other medical conditions you may have, and it will be determined in consultation with your healthcare provider.
Needling
With this method, the tissue cord that is contracting a finger is punctured and broken using a needle introduced through numbed skin. Contractures frequently reoccur, but the procedure can be repeated if needed.
The needling method offers a number of benefits. No deep wounds need to heal. Several fingers can undergo the procedure simultaneously. It might be completed in an office rather than in the operating room. One drawback is its limited applicability in certain finger locations due to the potential risk of nerve or tendon damage.
Injections
- Steroids. Steroid injections into the hard lump may help flatten and soften it in the early stages of the disease. These injections might also aid in nodule pain relief.
- Collagenase. This is an enzyme that can be injected into the hard lumps and cords to soften and weaken them. Within the next week, at a second session, your hand will be moved in a way that will break up the cords and straighten your finger. For several years, this can lessen or perhaps completely cure the contracture.
Radiation Therapy
If you need radiation therapy to treat Dupuytren contracture or stop the progression of your symptoms, your doctor could suggest seeing a radiation expert. Radiation therapy is a painless process that softens nodules or cords by directing X-rays or other beams towards them.
Certain cancers are treated with radiation treatment. However, having Dupuytren contracture does not indicate that you currently have cancer or will eventually get cancer.
Surgery
For individuals with severe symptoms of Dupuytren contracture, surgery may be necessary to remove the tissue causing the bending of the fingers. Generally, surgical procedures provide a more comprehensive and long-lasting release compared to needle or enzyme procedures. However, the recovery time is typically longer.
In extreme cases surgeons may need to remove all the tissue that could be affected by Dupuytren contracture including the skin. In such situations, an open incision may require a skin graft to cover it. This is the most invasive procedure with the longest recovery period.
It’s important to note that any treatment for Dupuytren contracture may provide only temporary relief, as the contraction of the fingers can often recur over time.
