Tag Archives | fibromatosis

Dupuytren Finger

Dupuytren Contracture or Morbus Dupuytren, Palmar Fibromatosis or Dupuytren’s disease is a thriving and inherited connective tissue which interferes with the straightening and bending of the fingers. A working knowledge on Dupuytren contracture symptoms and treatment is required for patients to get through the condition with less hassle.

Dupuytren Finger

Affected areas generally include the pinky and ring finger. As the condition becomes worse, it would only be matter of time before it includes the middle finger. The condition deteriorates slowly in a usually painless manner. A patient with Dupuytren finger will observe the palmar fascia thicken, then tendons thicken and the alterations in the movements of the fingers.

This condition has a greater chance of manifesting in men nearing age 40. But at the age of 80, both female and male will have a similar chance of getting Dupuytren Contracture.

The cause of the disease hasn’t been discovered yet. Recent studies revealed that these conditions could be linked to autoimmune reactions. Such reactions cause an individual’s autoimmune system to ravage its own tissues and gradually attack other parts of the body like the genitals and feet. It’s hard to figure out the symptoms since the disease develops slowly and painlessly. But some of the symptoms you can detect include the following:

Starting Symptoms

At the start of the disease, you will observe a thickening on your palm’s skin. As the disease develops, the skin over your palm will appear dimpled and wrinkled. You will observe a hard lump of tissue growing on the palm which may react to touch although generally painless.

Late Symptoms

As the disease worsens, the tissues beneath the skin will bend slowly towards the fingers and slowly tighten up. For serious cases, the fingers can be pulled towards the palms and make it hard for you to keep them straight.

In majority of cases, the pinky and ring finger are the ones that are commonly affected. It is only a rare occasion when the index finger and thumb are affected. For 45% of the cases, Dupuytren’s contracture affects both hands but one hand would appear more affected than the other. The disease affects the soles and toes only on rare occasions.

Dupuytren Finger

For severe cases, the condition may give both you and your family some problems. It will be hard for you to do the simplest tasks. It is even more difficult for you to shake someone else’s hand.

Should you observe these symptoms, it is best to seek medical support and obtain the advice of a physician so that treatment can be administered as soon as possible.

Treatment for Dupuytren’s Contracture

Treatment for the disease is administered to revive the affected hand in the best way possible. Treatment would consist of:

  • Injection
  • Surgery

Surgery is advised for contractures that limit the functionality of one’s hand. Surgery will entail the opening of the skin on affected areas and operating on the fibrous tissue. Your first surgery may not be enough and another surgery may be needed if the condition recurs.

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Fibromatosis Hand

Unusual hand curvatures and abnormal hand flexion, these can all be caused by fibromatosis. A broad medical term, fibromatosis includes a group of ‘mutated’ cells, producing a scar tissue with a distinct biologic behavior. Oftentimes, this is related to an auto-immune disorder, where the body’s own immune system destroys or damages own cells. Although considered benign or localized, the scar tissues have infiltrative growth, thus forming tumor-like lesions and have a tendency towards recurrence. What happens with fibromatosis at your hands?

Fibromatosis hand or palmar fibromatosis is medically called Dupuytren’s disease or contracture. Commonly affecting the hands of adults aged 50 and above, thick cord-like structures or lesions form at the palm of the hand causing the fingers to bend down slowly towards the palm. Definitive diagnosis for this is the table top test. With this, the patient places his hand flat on the table. If the hand cannot lie completely flat on the table with a space from the hand to table is as big as the diameter of a ballpoint pen, then the test is positive and treatment may be required.

Fibromatosis Hand

However, treatment of the disease can be delayed as symptoms occur very slowly and possible causes are not yet identified. Risk factors such as age, family history, a North European race, diabetes, smoking and alcohol use may increase chances of having it. Once positive, treatments are then based on its severity. Mild cases – those that do not impact one’s hand abilities – can do home remedies which are aimed towards avoiding or minimizing hand flexion. Meanwhile, severe cases are encouraged whether to undergo enzyme injection, needling, or surgical procedures to remove or puncture the cord-like formation.

Fibromatosis Hand

Dupuytren’s disease is fibromatosis at your hands! One’s genes might make you at risk of having it, but ‘loving’ your hands and ‘using’ it wisely, plus a healthy lifestyle, hold the definite key to avoid the disease, and even other fibromatosis!

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Dupuytren’s Contracture of the Foot Rediscovered and Redefined

Ever heard of Dupuytren’s contracture of the foot? Nah, contracture of the hand is more popular but abnormal foot flexion is seldom discussed. What it is and what actions should we take to treat, or possibly, to prevent it?

Dupuytren’s Contracture of the Foot Rediscovered and Redefined

Dupuytren’s contracture of the foot is known as Ledderhose’s disease (LD), plantar fibromas or Morbus ledderhose. Like the hand disease, it is a type of fibromatosis – scar tissues developing inside, usually under the skin. Causes are still unknown but it is closely related with autoimmune diseases. Our body’s immune system destroys our own cells and forms scar tissues and accumulates excess collagen. What a weird yet hideous way of betrayal inside our body!

As exact causes are still unknown, risk factors are identified for precautions, early detection, and treatment. A person with family history of both Dupuytren’s curvature of the foot and the hand may incur the disease, much worse, when he is a Caucasian male with over 70 years of age. A person with other health problems such as diabetes mellitus, epilepsy, liver disease, and thyroid problems poses higher threat of acquiring it. Smoking and alcohol use can stimulate cell mutation – leading to an abnormal immune response – thus, both lifestyle-related factors have been included. Foot trauma and overuse of the feet may also place you at risk, as well as punctures – wounds or tears can cause fibromas or scar tissues.

What happens with Ledderhose’s disease? Scar tissues, as above, also called plantar fibromatosis grow on the plantar surface or the sole of the foot. These are firm masses that grow slowly along the plantar fascia- which runs from the heel to the toes on the bottom of the foot- containing excess collagen or fibrotic tissue. At earlier stages, fibromas are small and do not impact foot’s ability. As they grow bigger at your sole, flexing your foot or bending the toes becomes more difficult and walking becomes painful. Early symptom includes a painful and noticeable lump in the arch, firm to touch and grows over time. Multiple fibromas may develop or they can merge to form a unified lump! As they grow in size, wearing shoes or walking barefoot might be very painful.

Dupuytren’s contracture of the foot is diagnosed by excising a part of the fibroma. Most of the time, the disease can be confirmed. But to visualize this, imaging studies are done such as MRI. MRI results shall help the doctor to determine shape, size and depth of the fibroma. In most cases, it even reaches the aponeurosis – the flat, fibrous sheet of connective tissue that attaches muscle to the bone. A thorough medical history shall also be taken to identify predisposing and precipitating factors leading to the disease.

Dupuytren’s Contracture of the Foot Rediscovered and Redefined

Once diagnosed, treatment shall proceed based on the size and location of the fibroma and the pain it causes. Small fibromas causing minimal pain shall include treatments aimed to alleviate direct pressure on it. This is done through padding, functional foot orthotics, heel lifts, night splints or arch support. Reduction of pressure does not only minimize pain but shows to shrink the lump. Verapamil gel, a calcium channel blocker, usually used for cardiac problems, is applied to the mass twice daily to ‘constrict’ the fibroma.

For larger fibromas that inflict greater pain, two invasive treatment options are available. Cortisone injections stall the progression of the disease temporarily but may also induce inflammation. Surgery can also be done but with more accuracy and care since nerves, tendons, and muscles are located in the foot.

Now that you have rediscovered and redefined Dupuytren’s curvature of the foot or Ledderhose’s disease, you might think about your chances of acquiring it and ways of preventing it. Remember, prevention by being aware and living a healthier lifestyle is still the best deal than starting a cure!

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Dupuytren’s Contracture Surgery

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

Dupuytren’s Contracture Surgery

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.

Needling

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.

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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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