Dupuytren’s Contracture

Dupuytren’s Contracture is a hand deformity that was named after Baron Guillaume Dupuytren, the surgeon that discovered an operation to correct the problem. The deformity is described as one where a thick layer of scar tissue begins to form underneath your skin, slowly and painlessly. The collection of the scar tissue begins to transform into a cord that slowly pulls your finger (or fingers) inward, toward your palm. After this whole process occurs, it will be impossible for your fingers to ever straighten completely. But worry not, for not all patients who display symptom logy will have the deformity progress far enough to restrict activities of daily life.

Symptoms and Prevention

There is no way to completely prevent Dupuytren’s Contracture, but having awareness of the symptoms and knowing what to look for will allow you to know whether your affliction is worsening or not. Usually the three things you will need to look for are this: a curled finger that you can’t seem to straighten as much as your other fingers. If this is the case, you should start looking around the base of your finger. If you see a node at the base, then that may be a sign of Dupuytren’s Contracture. The node can be described as a tender lump that feels like it is pulling the skin underneath your palm and your finger together. It may feel tight at first, and it’s supposed to, but that feeling may go away. So don’t let it deceive you if it is no longer feeling pulled. Finally if you see something that looks like a wire beneath your skin, below your finger, that is a surefire sign that you have Dupuytren’s. This is the symptoms doctors look for when they diagnose and test for Dupuytren’s Contracture. This band of tissue, as medical professionals call it, will look like a thin wire connecting your palm to the base of your finger. The wire will be raised above the rest of your palm, while remaining beneath the skin, and will generally be painless.

These are the symptoms of Dupuytren’s Contracture, and if you catch them early, you will be able to go to your doctor and get early measurements. With early measurements, your doctor can tell you how quickly (or in most cases, how slowly) the deformity is spreading. If it is growing slowly, there may be no need for any operation or medical treatment, as it doesn’t necessarily impact your daily life to the point of impeding occupational or social interaction. However, if the symptoms grow rapidly, it can reach the end phase much sooner and drastically affect the use of your hands. You may not be able to grip items properly or hold things with full strength. It is because of that difference in early stage Dupuytren’s and late stage Dupuytren’s that makes it vital to catch it before it gets worse.

Treatment For Dupuytren’s

Treatment for Dupuytren’s will vary according to whether the deformity is treated early or late. If it is treated early, radiation therapy has been proven to greatly reduce the growth of nodes and tissue, which in turn, prevents further symptomology in the fingers. Through treatment of sending various rays (X-Ray and E-beam) through the bands of tissue and the nodes of flesh for five days, the radiation stunts the growth of the malignant tissue and stops the progression of the disease. This radiation method is documented to have a success rate of 85%.

However, for late stage treatment, it is necessary to have surgery on the hand in order to fix the problem. The two types of late stage surgery include invasive and noninvasive. However, both types of surgeries have various treatment methods as well. The invasive surgery consists of cutting a zig zag down the band of tissue and literally removing all pathological tissues. This is the most commonly used method of treatment because it is a guaranteed method of removal, paired with a low risk of surgery residuals. The only downside is it is known to be painful and tends to flare up after surgery.

The noninvasive surgery (which is actually minimally invasive) doesn’t remove all of the pathological tissues, but rather removes enough of it so that the fingers no longer contracts toward the palm. So instead of having a tight cord pulling the two together, all that remains is a lump of excess flesh that is hardly noticeable. There are not many downsides with this method of treatment besides the difficulty for the surgeon to operate in a limited amount of space, without cutting important neurovascular tissue. Other than that, the patient only needs to wear a splint for two to three weeks while taking physical therapy to regain the usage of the fingers affected.

Another minimal invasive surgery technique uses a needle to insert into the cord. This weakens the tissue to the point that extending it fully would snap it. So by carefully poking at the cord in several different spots (depending on the length of the band), the surgeon is able to fully extend the patient’s finger in order to snap the band. This treatment requires no physical therapy, no splint, and doesn’t require an incision. However, it isn’t very often used because the nodes remain underneath the skin. Since the nodes are still there, it is possible for the band to start growing again, and thus, for the condition to resurface.

Pathology of Dupuytren’s Contracture

No one is sure what the precise cause of Dupuytren’s Contracture is; however, there is a fair amount of statistics on the disease itself.

Based on statistics, it is more commonly found in people of Northern European descent. It is often hereditary, so it’s important to take a look at your family history for this type of affliction. Finally, the older you get, the more likely it is for this disease to surface. At the age of 40, it occurs more commonly in men, but by the age of 80 the distribution between genders stabilizes.

Those are some of the falsifiable factors, but there are more factors which medical professionals think affects a person’s chances of getting Dupuytren’s. Some of these include: drinking alcohol, having diabetes, having a past seizure, or even liver disease. While these aren’t proven to be actual causes of Dupuytren’s, they are things you should consider if you are already at risk of getting the disease.

We do know that this disease is not manifest from the overuse of the fingers, previous injury to the hand, or overextending the fingers. So if any of this applies to you, you do NOT have to worry about Duputren’s affecting you.