Dupuytren’s contracture, Dupuytren’s Disease, Morbus Dupuytren or Palmar Fibromatosis causes flexion contractures on the hands where fingers flex towards the palm and can’t be fully straightened or extended. The disease was named after Dupuytren, Guillaume, a surgeon who was the first to describe the surgical correction for the condition. Dupuytren’s Contracture Surgery is a common treatment method for this condition.
The disease is due to the abnormal thickening of connective tissues under the skin. Such thickening is known as Palmar aponeurosis or fascia. Such thickening takes place at the palm of your hands and extends to the fingers. Lumps and firm cords may accumulate and cause the bending of fingers from behind and towards the palm.
The development of the condition may also involve the skin and other deep sutures-like tendons – although not directly. The disease will occasionally thicken at the top of the finger’s knuckles or knuckle pads, cords, or nodules inside the plantar fibromatosis or soles of the feet.
Cause of Dupuytren’s Disease
What exactly causes Dupuytren’s Disease still remains a mystery. Certain bio-chemicals inside the affected fascia have been associated to it. Specific associations have also been linked to:
- Northern or Scandinavian ancestry. It has been called “Viking’s disease,” and in certain Mediterranean countries like Bosnia, Spain and Japan.
- Men at the age of 40 years and above. Statistics revealed that men have ten times more tendency to get the disease than women.
- Family history and ancestry. 70% of the cases have been associated to genetic predisposition of the disease.
Though not conclusive, Dupuytren’s contracture is also associated to diabetes, trauma, tobacco use, alcoholism, phenytoin and liver disease treatments in epilepsy.
Specific occupations and hand injuries have been suggested to increase the risks, although no conclusive evidence supports the suggestion. The disease may be triggered by manual labor and over-exertion of the hands which can cause trauma to certain areas of the hands. The disease though doesn’t always take place on the dominant hand and has nothing to do with right or left handedness.
Signs and Symptoms of Dupuytren’s Disease
With Dupuytren’s disease, connective tissues of the hands become unusually thick and such thickness causes the furling of the fingers and result in impairing the function. The ring and index fingers are the ones that are usually involved. In some instances, both of the hands get it, though the extent may differ in both hands.
Symptoms for Dupuytren’s Disease involve the formation of cords, bands, pits, and lumps inside the palm. Progression can’t be predicted. A number of individuals will only have small cords and lumps while others develop bent fingers. Individuals with serious conditions will experience the symptoms at an early age.
The disease generally begins with a minimal and tender lump within the palms. Such discomfort is not yet a burden and the disease isn’t really painful. In due time, hard bands may develop on the tissues which should be visible on the palm’s surface and appear like a small callus. The nodules or lumps then become adherent and firm over the skin.
As fascial bands become thick, they will form cords that will extend from the palms within one or more of the fingers and cause bending or tethering and contractures over the fingers. This causes the reduction of mobility which is commonly linked to the condition. Such cords may also sometimes be mistaken as tendons though they lie in between the tendons and skin. The disease can first be observed when the individual finds it difficult to put his hand flat over a flat surface like a tabletop.
Contractures develop very slowly in women. But serious conditions progress faster and affect both hands which can be associated to the foot. As the disease develops, patients will experience difficulty in doing simple activities like washing up, shaking hands, adjusting their hands inside the pocket and wearing gloves.
Surgery as Treatment
Surgery may be necessary in a number of cases and definitely needed on serious cases that involve the knuckle or metacarpophalangeal joint, fast progression and difficulty in motion and functionality. It is the aim of surgery to eliminate the lump of tissue on your palm. This could be a challenge because it’s very hard to determine the tissue in its early stage. The tissue may also connect towards the skin and make it hard to eliminate and increase the chances of regeneration.
What’s good about surgery though is that the complete joint is released more than what an enzyme or needle can provide. Physical therapy may be required right after surgery and recovery may take more time to take effect. Skin grafts may also be required on an occasional basis to cover up the wounds after an extensive removal of the affected tissue.
The technique uses needles inserted in the skin to break and puncture the tissue cord that contracts the finger. Contractures usually recur but the process can be done again. A number of doctors use ultrasound to direct the needle. This will also reduce the chances of acquiring injury on the tendons and nerves.
The good thing about needling technique is that there are no incisions involved. It can be applied on fingers and generally little therapy is required after the procedure. It can’t be used on certain locations within the fingers because it may disembowel a nerve.