The Collison Newsletter March 2013

                   DUPUYTREN’S CONTRACTURE*  

 

Dupuytren's contracture is a thickening and shortening of the palmar fascia, that gradually causes clawing of the fingers as they are pulled towards the palm. The ring and little fingers are usually affected. The palmar fascia is a deep layer of tissue found in the palm of the hand, extending from the palm to the fingers.

 

Dupuytren’s contracture is described as a fixed flexion contracture of the hand, where the fingers bend towards the palm and cannot be fully extended (straightened).

 

The condition is named after Baron Guillaume Dupuytren, a famous French surgeon who, in the Lancet in 1831, described an operation to correct the affliction.

Symptoms of Dupuytren's Contracture 

In Dupuytren's contracture, the palmar fascia within the hand becomes abnormally thick, which can cause the fingers to curl and can result in impaired function of the fingers. The little and ring fingers are especially affected. The middle finger may be affected in advanced cases, but the index finger and thumb are nearly always spared.

 

Features of Dupuytren's contracture:

  • It often starts with a lump or nodule, or several nodules, in the palm of the hand, usually close to the base of the little and/or ring finger. 
  • There is the appearance of a thickened cord running along the palm to the fingers. 
  • The contracture generally progresses slowly. However, the rate at which the contracture develops varies enormously from person to person. When it develops later in life, it tends to progress more slowly. 
  • Over time, as the contracture progresses, the fingers become clawed as they are pulled towards the palm. 
  • The skin of the palm is dimpled and puckered. 
  • Untreated, in the worst cases, the fingers can become completely pulled against the palm. 
  • Finger joints may become fixed and rigid. 
  • Pain is not usually present (there may slight pain for several weeks after the onset).

The Cause of Dupuytren's Contracture

 

The palmar fascia becomes abnormally thick due to the fact that there is a change of collagen type. Normally, the palmar fascia consists of collagen type 1. Collagen is a group of naturally occurring proteins found in connective tissue, and is the main component of connective tissue. Collagen type 1 is typically found in skin and tendons and other organs. In Dupuytren's contracture, the collagen type 1 changes to collagen type 3, which is significantly thicker than collagen type 1. This change progresses slowly.

 

The exact trigger that causes the change in collagen to take place, causing the palmar fascia to thicken and contract, is unknown. Some researchers have speculated that it may be associated with an autoimmune reaction, where a person's immune system attacks its own body tissues. Dupuytren’s contracture may occur in concert with conditions that cause contractures in other parts of the body, such as the feet or penis.

 

Risk or Contributing Factors for Dupuytren's Contracture

  • Age. The condition is more common in middle to later years of life, occurring most commonly after the age of 50 years. 
  • Gender. Men are more likely (up to 10 times) to develop Dupuytren's contracture than women, and have more severe contractures. After the age of 80, the gender distribution is about even. 
  • Heredity. The condition often runs in families. 
  • Ancestry. People of Northern European descent (especially Celtic or Scandinavian ancestry) are at higher risk of the disease. 
  • Diabetes. People with diabetes are reported to have an increased risk of Dupuytren's contracture. 
  • Tobacco and alcohol use. Smoking and alcoholism are both associated with increased risk of this condition and, in the case of alcoholics, (especially if there is cirrhosis of the liver) the contracture is comparatively more severe.

Complications of Dupuytren's Contracture

 

Dupuytren's contracture can make it difficult to perform certain functions using the hand. Since the thumb and index finger are not usually affected, many people do not experience much disability or inconvenience with fine activities such as writing. But as the condition progresses, it can limit the ability to fully open the hand, making it difficult to grasp large objects or to get the hand into narrow spaces.

Diagnosis of Dupuytren's Contracture 

In most cases, doctors can diagnose Dupuytren's contracture simply by looking at and feeling the hands, so other tests are rarely necessary.

Treatment of Dupuytren's Contracture 

If the contracture progresses slowly, is painless (as it generally is) and has little impact on your ability to use your hands for everyday tasks, no treatment is necessary.

 

Treatment involves removing or breaking apart the cords that are pulling the fingers towards the palm. This can be done in several ways. The choice of procedure depends on the severity of the symptoms (and possibly other health issues). The method selected will depend on your doctor and includes:

  • Needling 
  • Enzyme injections 
  • Cortisone injection 
  • Surgery 
  • Radiation.

If there is only mild contracture, self-help can be carried out by stretching (bending the fingers backwards from the palm) and massage of the nodules and cords with a cream such as lanolin, or one containing vitamin E.

 

*Copyright 2013: The Huntly Centre. 

Disclaimer: All material in the huntlycentre.com.au website provided for informational or educational purposes only. Consult a health professional regarding the applicability of any opinions or recommendations expressed herein, with respect to your symptoms or medical condition.

 

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