About dupuytren's contracture

What is dupuytren's contracture?

Dupuytren's contracture facts

  • A Dupuytren's contracture is a localized scar tissue formation in the palm.
  • The precise cause of a Dupuytren's contracture is not known.
  • A Dupuytren's contracture is sometimes inherited.
  • A Dupuytren's contracture can limit extension of the affected finger.
  • The treatment of a Dupuytren's contracture depends on the severity and the underlying condition of the affected individual. Treatments include stretching, heat, ultrasound, local cortisone injection, surgical procedures, and collagen injection.

What is a Dupuytren's contracture?

A Dupuytren's contracture is a localized formation of scar tissue around the tendons that flex the fingers beneath the skin of the palm of the hand. The scarring accumulates in a tissue (palmar fascia) that normally covers the tendons that pull the fingers to grip. As a Dupuytren's contracture progresses, more of the fascia becomes thickened and shortened. Dimpling and puckering of the skin over the area eventually occurs and ultimately can make it impossible to fully extend the hand (as in laying it flat on a tabletop).

How fast does a Dupuytren's contracture develop?

A Dupuytren's contracture varies in its rate of progression from minor skin puckering for many years to rapid contracture (fixed flexed position) of fingers.

What are the symptoms for dupuytren's contracture?

Tender knuckle pads symptom was found in the dupuytren's contracture condition

Dupuytren's contracture typically progresses slowly, over years. The condition usually begins as a thickening of the skin on the palm of your hand. As it progresses, the skin on your palm might appear puckered or dimpled. A firm lump of tissue can form on your palm. This lump might be sensitive to the touch but usually isn't painful.

In later stages of Dupuytren's contracture, cords of tissue form under the skin on your palm and can extend up to your fingers. As these cords tighten, your fingers might be pulled toward your palm, sometimes severely.

The ring finger and pinky are most commonly affected, though the middle finger also can be involved. Only rarely are the thumb and index finger affected. Dupuytren's contracture can occur in both hands, though one hand is usually affected more severely.

What are the causes for dupuytren's contracture?

Doctors don't know what causes Dupuytren's contracture. There's no evidence that hand injuries or occupations that involve vibrations to the hands cause the condition.

What are the treatments for dupuytren's contracture?

The treatment of a Dupuytren's contracture depends on the severity and the underlying condition of the affected individual.

Most patients with a Dupuytren's contracture require reassurance and stretching exercises with heat application. When the palm is persistently sore with grasping, ultrasound treatments can be helpful. Sometimes local inflammation is best relieved with cortisone injection.

For patients with significant fixed flexed posture (contracture) of the fingers from a Dupuytren's contracture, when nonsurgical treatments have failed, surgical procedures can remove the scarred tissue to free the fingers and release the tendons. These procedures can return function to a disabled hand. Minor nodule formation and/or skin thickening of the palm is not a reason to operate. Sometimes the surgeon can release the scarred tissue by carefully cutting it with a needle. This procedure is referred to as a needle aponeurotomy or needle fasciotomy.

A newer treatment for a Dupuytren's contracture is collagenase (Xiaflex) injection. The scar tissue that forms the contracture is composed of a protein network called collagen. Collagenase is an enzyme that breaks up the collagen, which can then loosen the contracted tissue to restore finger mobility. Collagenase is directly injected into the contracted "cord" of scar tissue that causes the Dupuytren's contracture.

What are the risk factors for dupuytren's contracture?

A number of factors are believed to increase your risk of the disease, including:

  • Age. Dupuytren's contracture occurs most commonly after the age of 50.
  • Sex. Men are more likely to develop Dupuytren's and to have more severe contractures than are women.
  • Ancestry. People of Northern European descent are at higher risk of the disease.
  • Family history. Dupuytren's contracture often runs in families.
  • Tobacco and alcohol use. Smoking is associated with an increased risk of Dupuytren's contracture, perhaps because of microscopic changes within blood vessels caused by smoking. Alcohol intake also is associated with Dupuytren's.
  • Diabetes. People with diabetes are reported to have an increased risk of Dupuytren's contracture.

Is there a cure/medications for dupuytren's contracture?

Dupuytren's contracture is a benign disease whose etiology is similar to that of Peyronie disease, Ledderhose disease, and Garrod disease. It predominantly affects the palmar part of the hands. The disease initiates with nodules along the longitudinal lines of tension.

Treatment /management

  • Treatment options consist conservative management, needle aponeurotomy, collagenase injection, or surgical resection and fasciectomy.
  • Follow-up observation every six months is necessary to track the progression.
  • Physical and occupational therapy, including ultrasonic waves and heat is preferable in the early stages.
  • Corticosteroids help painful nodules at the possible risks of fat atrophy, pigmentation change, and rupture of the tendons.
  • Radiation therapy may work for early stages but involves complications.
  • Needle Aponeurectomy - it is the choice for mild contractures and has the best outcomes on Metacarpal-phalangeal joint contractures.
  • Collagenase injection - the treatment involves injecting collagenase into the cords, subcutaneously, followed by manipulation of the digit after 24-48 hours, under anesthesia. Night splinting is maintained for six months.
  • Surgical fasciectomy- in the palm of the affected hand, the fascia becomes abnormally thick along the contractures. Fasciectomy involves resection of the fascia. Partial palmar fasciectomy limits the resection of disease tissues, whereas total fasciectomy involves resection of non-diseased tissue as well.

Tight and bent fingers,Bumps in the hands,Tender knuckle pads,Restricted movements of fingers,Pain around the joints
Knots of tissue form under the skin creating a thick cord that can pull one or more fingers into a bent position

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