Dupuytren'S Contracture

1 What is Dupuytren's Contracture?

Dupuytren's contracture is a disease in which the layer of tissue under the skin is affected leading to the formation of knots of tissue under the skin of the palm.

These knots may eventually form thick cords that can pull one or more fingers towards the palm. This hand deformity usually develops over a period of years.

Performing certain daily activities such as placing the hands in the pocket, putting on gloves or shaking hands may become difficult since the fingers cannot be straightened completely.

This disease mostly affects men of Northern European descend. The ring finger and pinky are mostly affected although the middle finger can also be affected. There are several treaments that can slow the progression of Dupuytren's contracture and relieve symptoms.

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2 Symptoms

The signs and symptoms of Dupuytren's contracrure include:  

  • Thickening of the skin on the palm of the hand
  • Puckered or dimpled skin on the palm as the condition progresses
  • A firm, painless lump of tissue on the palm. This lump may be sensitive to the touch.
  • Later cords may appear under the skin of the palm
  • Fingers that are pulled towards the palm
  • Inability to straighten the hand

Rarely are the thumb and index fingers affected. A period of several years are required for Dupuytren's contracture to progress.

3 Causes

There is no known cause for Dupuytren's contracture.

4 Making a Diagnosis

A physical exam is usually used for the diagnosis of Dupuytren's contracture to be made.

A doctor may look for signs of puckering on the skin of the hands and press the hands or fingers to check for toghened knots or bands of tissue under the skin of the palms.

Doctors can also ask the patient to place the hand on a flat surface. If a patient is not able to fully flatten the fingers it can be an indication that a patient has Dupuytren's contracture.

Other tests are rarely required for the diagnosis of this disease.

5 Treatment

Mild cases of Dupuytren's contracture may not require treatment. Treatments for severe cases of this disease involves removing or breaking apart the cords that are pulling the fingers towards the hand.

The choice of the procedure to use depends on the severity of symptoms and the presence of any other underlying health problem.

Procedures that can be used include:

  • Needling - a technique in which a needle is inserted through the skin, to puncture and break the cord of tissue thats causing the fingers to contract. This technique can be performed on several fingers at the same time and does not require an incision. Physical therapy is rarely require when this procedure is used. However, contractures can recur despite repeated treatments.  
  • Enzyme injections into the cords to soften and weaken them. Later on doctors manipulate the hand in an attempt to break the cords and straighten the fingers.
  • Surgery is recommeded for cases of Dupuytren's contracture that have progressed. The main advantage of surgery is that it resylts in a more complete and longer lasting release than that provided by needle and enzyme methods. The main disadvantage is that months of physical therapy is required after surgery and recovery may last longer as compaired to the other procedures.

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with Dupuytren's contracture.

Avoiding a tight grip on tools by building up the handles with pipe insulation or cushion tap and using gloves with a heavy padding during heavy grasping  tasks can help to prevent Dupuytren's contracture from getting worse.

7 Risks and Complications

The risk factors for having Dupuytren's contracture include:

  • Being older than than 50
  • Men of Northern European descent
  • Tobacco and excessive alcohol consumption
  • Having diabetes

Dupuytren's contracture can maker its difficult to perform certain functions using tha hand. However, fine motor skills such as writing are rarely affected since the thumb and index finger are not affected by this disease in most cases.

Dupuytren's contracrture can limit a person's ability to fully open the hand, grasp large objects or to get the hand in narrow places.