In Focus: Palmar Fibromatosis

Our hands are man’s productivity tool. Being aware of what may inflict them is a key to protect them, just like how palmar fibromatosis affected the hands of powerful history makers, Napoleon Bonaparte and Ronald Reagan.

Palmar fibromatosis, morbus Dupuytren or simply known as Dupuytren’s disease is a hand contracture characterized by the thickening and tightening of the fibrous tissue on the palm of the hand, called the palmar fascia. This causes the bending of the fourth and oftentimes, the fifth finger, towards the direction of the palm.

The challenge with this disease is not just spelling out Dupuytren’s or palmar fibromatosis. The real issue is all about knowing what really causes its occurrence. Named after Baron Guillaume Dupuytren, the surgeon who first described the operation to correct it in 1831, the disease is still an open maze for medical scientists. Although the cause is unknown, the disease tends to run in families. This genetic predisposition is further amplified for those of Northern European descent. Legendarily believed as a disease initially inflicted by the Vikings who have conquered Europe, palmar fibromatosis is also called the Viking’s Disease. In the battle of men versus women, the disease tends to go with men’s strong claw-like hands, and usually starts at age 40 then progresses slowly. The incidence is also greater for people who have existing diseases such as diabetes mellitus, epilepsy, pulmonary disease and liver problems. Plus, alcohol drinking and smoking can augment chances of having it, too, as they increase chances of cell mutation due to lack of oxygenation.

How does palmar fibromatosis happen? Under normal conditions, strips of fibrous tissues, usually soft and pliable, lie under the skin of the palm. This is called the palmar fascia. But in people with Dupuytren’s disease, certain cellular changes occur. Thus, most researchers relate the disease to autoimmunity – our body cell becomes overactive that they attack our very own cells. This process enables scar tissue formation. These scar tissues that develop on the palmar fascia create cords or nodules which tighten and contract the connective tissue. As the palmar fascia tightens, our fingers are bent towards the palm, and cannot be straightened. The process usually starts at the crease on the palm of the hand, and progresses at the joint near the base of the finger, then to the next joint of the same finger. The ring finger is usually the first victim, followed by the little finger. The condition may appear suddenly, yet it progresses slowly that the symptoms are quite unnoticeable, until it becomes severe and life-changing.

How is palmar fibromatosis diagnosed? Simple and easy, the table top test provides the answer. How is it done? A person is instructed to place his hand completely flat on the table. Inability to do so, or existence of even a space as big as a diameter of a ball pen, shall confirm the test, as positive. To determine the gravity of the condition and the location of the nodules, the doctor shall advise the patient to undergo a series of imaging studies and a comprehensive medical history. When a contracture is mild and a person is able to do normal activities, treatment shall focus on preventing further contractures. Stretching your fingers backward from the palm or placing your fingers at the edge of the table with palms down and then lifting the palm upwards gradually is one simple home remedy. Massage with lanolin cream and application of microwavable heat packs before stretching are also helpful. Most importantly, protecting the hands by building up handles with pipe insulation or cushion tape or heavy paddings for grasping tasks prevents the occurrence of further hand injuries and deformities.

If the palmar fibromatosis progresses severely that significant hand activities are interfered, then, conservative treatments are out. Here comes the more advanced and aggressive type. Generally, this kind of treatment aims to break or remove the cords or nodules that tighten the fascia and bend the fingers. The choice of procedure still depends on how worse the case is.

In Focus: Palmar Fibromatosis

Needling technique uses a needle, inserted through the skin, and acts to puncture or break the cord of tissue tightening the finger. A non-invasive option, it can also be done on several fingers at the same time and most often, little physical therapy is needed afterwards. Yet, chances of recurrence are high.

Likewise, enzyme injections involved injecting an enzyme towards the cord to soften and weaken it. Then, the doctor shall manipulate to break the cord and straighten the finger. Almost of the same benefits with needling, enzyme injection can be more painful initially.

Surgery is still the last resort if all things fail. It allows the doctor to surgically remove the affected tissues, liberate your palmar fascia, and straighten your fingers. Although, it promises a more complete joint release, recovery time and rehabilitation after surgery may take a longer time.

Palmar fibromatosis, Dupuytren’s contracture or whatever you call it, this hand-inflicting disease is indeed life-impacting. Remember, our hands no matter what size or looks they have, are still worth protecting!

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