Dupuytren contracture is a possibly debilitating deformity of the hand that results from the contracture of the hand’s palmar fibrous tissue. Usually, the affliction involves a person’s small and ring fingers and may cause the joints of the said fingers to be in fixed flexion. A fibrosing disorder that leads to the palmar fascia’s gradual and continuing thickening and shortening, Dupuytren’s contracture can be counted as part of the fibromatoses classification of diseases, which also includes the plantar (feet) version called Ledderhose disease. Below is more information on Dupuytren contracture:
Causes and Predisposing Factors
No one can say exactly what the cause of the contracture is. Most cases seem to be idiopathic and aren’t accompanied by other coexisting disorders. Despite this, a number of factors have been identified as common among a considerable percentage of those afflicted with the condition.
Genetics, among others, is one such factor. About 60 to 70 percent of Dupuytren contracture patients have a familial predisposition to developing it. Furthermore, there are individuals from certain ancestries who are more likely to get the disease. The condition is widespread in a handful of Mediterranean countries as well as in Japan. Four to six percent of Caucasians worldwide are affected, too. Males, as well as people above the age of 40, are more likely to get the condition.
There are also some speculations that hand injuries and manual labor with exposure to vibration may cause one to develop the contracture. These claims haven’t been proven, and there’s reason enough to doubt the veracity of these theories. Other risk factors include hyperlipidemia, smoking, liver disease, Peyronie disease, and Diabetes Mellitus.
Manifestations and Diagnosis
Aside from the obvious deformity, there are other signs that may indicate that you have the disorder. In the early phases of the disease, you can usually find small lumps or nodules in your palm. You may also find some areas of dimpling in your palm’s skin. As the disease progresses, a rope-like cord may appear and extend to your fingers, usually the ring and small fingers, and pull them towards your palm, hence, the contracture.
Aside from taking the client’s history and doing a physical examination to check for the presence of the signs indicated above, a physician may also order some other tests. Since there’s no exact cause for the disease, it’s only logical that there’s no routine exam to confirm the diagnosis either. Nevertheless, since the contracture has been associated with diabetes, the doctor may have the fasting blood glucose level measured. The patient may also be asked to undergo an ultrasonography, which proves useful in demonstrating the presence of a lump, thickening of the tissues in the palm, and identifying the underlying tendons to be avoided when intralesional injections are administered.
Treatment of Dupuytren Contracture
It is important to understand that treatment of Dupuytren’s contractures is centered on preventing further disability and restoring function but that recurrence is common and no treatment can totally cure the disease. Finger stretching may be prescribed for the patient and is useful in the early stages of the disease, especially when combined with ultrasonographic waves and heat application. The patient may be asked to wear a custom-made splint or brace to further aid in stretching the fingers. The patient may also be required to perform range of motion exercises several times in a day. Occupational therapy is another useful addition to the treatment plan as it will help the patient in the use of assistive devices and techniques to improve his ability to function from day to day. Collagenase injections may also be given to dissolve the cords that come with Dupuytren’s disease. Lastly, other treatment options include radiation therapy and surgical interventions like fasciectomy, fasciotomy, and extensive percutaneous aponeurotomy & lipografting.
Granted, Dupuytren’s contracture can change your life forever as it can prevent you from functioning as well as you did before. However, with early detection and prompt treatment, you can catch and manage the disease before it wreaks debilitating havoc on your well-being.