Dupuytren's Contracture
Dupuytren's (du-pwe-TRANZ) Contracture is a hand deformity that generally develops over several years. The disease affects a layer of tissue that lies under the skin of your hand creating a thick cord that can pull one or more fingers into a bent position. The fourth and fifth digits (ring finger and the pinky), are the most commonly affected. But any of the fingers may be involved, including the thumb.
The fingers bend towards the hand and cannot be completely stretched out. This can complicate everyday activities such as placing your hands in your pockets, putting on gloves or shaking hands.
SYMPTOMS
Dupuytren's Contracture is a gradual shortening of the thin, tough, layer of fibrous tissue between the skin of the palm (known as the palmar aponeurosis or palmar fascia) and the underlying flexor tendons of the fingers.
The first sign could be a tender or painful lump in the palm of the hand. The bands may look like a small callus. Unusual dimples or lumps may appear in the palm, and the skin may pucker over the lumps.
As these tough bands of tissue develop, it becomes harder to stretch the hand. Eventually, the fingers cannot be fully straightened out. In about half of all cases, both hands are affected. Toes may be affected, but this is very rare.
The condition is not usually painful. As the symptoms go from mild to severe, an individual will find it harder to use the affected fingers.
RISK FACTORS
While the direct cause of Dupuytren's Contracture is unknown, certain risk factors may be involved:
Dupuytren's Contracture occurs most commonly after the age of 50.Men are more likely to develop the condition and to have more severe contractures than women.
The condition usually runs in families, which means it is inherited. You are more likely to develop this condition if you have a Northern European (English, Irish, Scottish, French, Dutch) or Scandinavian (Swedish, Norwegian, Finnish) background.
Smoking and alcohol are associated with an increased risk of Dupuytren's contracture, perhaps because of microscopic changes within blood vessels caused by smoking and drinking.
People with diabetes or epilepsy are reported to have an increased risk of Dupuytren's Contracture.
TREATMENT
Treatment for Dupuytren's Contracture depends on the severity of your condition. While treatment can help reduce symptoms, there is no cure and there is always a risk of recurrence. No single treatment method is appropriate for all cases and rates of success vary.
Nonsurgical Treatments
Multiple steroid injections arestrong anti-inflammatory medications that may reduce the size of nodules early in the course of disease
Enzyme injections into the affected area can break up the tough tissue. This treatment method is relatively new but is FDA approved and early results are promising. However, long-term results and recurrence rates are not yet known.
Low energy radiation therapy may help symptoms and prevent worsening of the cords, nodules, and skin changes in the contractures.
Splinting, vitamin E cream, and ultrasound are some of the other treatments that have been tried but generally have not been successful.
Surgical Treatments
Open surgery isan incision that either divides (fasciotomy) or removes (fasciectomy) part or all of the thickened bands of tissue. Sometimes a skin graft is needed for the incision to completely heal.
Needle aponeurotomy is a less invasive, alternative option to open surgery. This office procedure uses a hypodermic needle to divide and cut the diseased tissue in the palm and fingers.
As with any hand conditions, it is important to recognize early symptoms for the best course of treatment. If you feel you are experiencing signs of Dupuytren’s Contracture, contact our office for a consultation.
For more information or to request an appointment, please contact Dr. Patrick McDaid, M.D. at www.mcdaidorthohand.com/contact
