Last updated date: 27-Mar-2023
Originally Written in English
Dupuytren's Contracture What is it Symptoms, Causes and management
Dupuytren's contracture is a condition that affects the connective tissue in the palm of the hand. It causes the tissue to thicken and form a cord, which can pull one or more fingers into a bent position. The condition typically affects the ring and little fingers and may occur in one or both hands.
While there is no surefire way to prevent Dupuytren's contracture, there are some lifestyle changes that may help reduce the risk or delay its onset. These include quitting smoking, maintaining a healthy weight, eating a healthy diet, exercising regularly, managing diabetes, and protecting the hands from injury.
What is Dupuytren's contracture?
Dupuytren's contracture is a hand condition that affects the tissue beneath the skin of the palm and fingers. It causes the fingers to bend towards the palm and become stiff, making it difficult to straighten them. The condition is named after the French surgeon Baron Guillaume Dupuytren, who first described it in the early 19th century.
Dupuytren's contracture is caused by the thickening and tightening of a layer of tissue called the fascia, which lies beneath the skin of the palm and fingers. Over time, the fascia can form tough bands or cords that pull the fingers inward toward the palm, resulting in the characteristic "contracture" or bending of the fingers.
Dupuytren's contracture typically affects the ring finger and pinky finger, although it can also affect the other fingers. It tends to develop gradually over a period of years and may progress to the point where the affected fingers cannot be fully straightened.
What causes Dupuytren contracture?
The exact cause of Dupuytren's contracture is not known, but it is believed to be related to a combination of genetic and environmental factors. It is more common in people of Northern European descent and in men over the age of 50.
There are several risk factors that can increase the likelihood of developing Dupuytren's contracture, including:
- Genetics: The condition tends to run in families, suggesting that there is a genetic component.
- Age: The risk of developing Dupuytren's contracture increases with age.
- Gender: Men are more likely than women to develop the condition.
- Ancestry: People of Northern European descent are more likely to develop Dupuytren's contracture.
- Diabetes: People with diabetes have an increased risk of developing the condition.
- Alcohol consumption: Heavy alcohol consumption has been associated with an increased risk of Dupuytren's contracture.
- Smoking: Smoking has also been linked to an increased risk of the condition.
- Hand injuries: Injuries to the hand or fingers may increase the risk of developing Dupuytren's contracture, although the exact relationship is not well understood.
What are the symptoms of Dupuytren's contracture?
The main symptom of Dupuytren's contracture is the gradual development of thickened tissue under the skin of the palm and fingers, which can lead to the fingers bending toward the palm and becoming stiff.
Other symptoms of Dupuytren's contracture may include:
- Thickened skin: The skin on the palm of the hand may become thickened and develop pits or nodules.
- Inability to straighten fingers: The fingers may become progressively bent towards the palm, making it difficult or impossible to straighten them.
- Pain or discomfort: In some cases, Dupuytren's contracture can cause pain or discomfort in the affected hand.
- Reduced hand function: As the fingers become increasingly bent, hand function may be affected, making it difficult to perform everyday tasks such as gripping objects or shaking hands.
Symptoms of Dupuytren's contracture may develop gradually over a period of years and may affect one or both hands. The severity of the condition can vary widely, with some people experiencing only mild symptoms and others developing severe hand deformities that significantly impact daily life.
How is Dupuytren's contracture diagnosed?
Dupuytren's contracture is usually diagnosed based on a physical examination of the affected hand and fingers. During the exam, the doctor will assess the extent of the contracture and the thickness and texture of the tissue beneath the skin.
In some cases, imaging tests such as X-rays or ultrasound may be used to help diagnose the condition and rule out other possible causes of hand stiffness and deformity.
If there is a concern that the condition may be affecting the nerves in the hand, additional tests such as nerve conduction studies or electromyography (EMG) may be recommended.
It is important to note that Dupuytren's contracture is a progressive condition, meaning that it can worsen over time if left untreated. As such, it is important to seek medical attention if you notice any changes in the appearance or function of your hand or fingers. Early diagnosis and treatment can help prevent the condition from progressing and reduce the likelihood of complications.
How is Dupuytren's contracture treated?
The treatment for Dupuytren's contracture depends on the severity of the condition and the degree of functional impairment. In mild cases, no treatment may be necessary, and the condition can be monitored for changes over time.
In more severe cases, treatment options may include:
- Injections: Injecting medication such as collagenase or steroids into the thickened tissue can help soften the tissue and improve hand function.
- Physical therapy: A hand therapist can teach exercises to improve hand mobility and reduce stiffness.
- Surgery: Surgery may be necessary in more severe cases to remove the thickened tissue and release the contracture. The type of surgery used will depend on the extent and location of the contracture.
- Radiation therapy: In some cases, radiation therapy may be used to slow the progression of Dupuytren's contracture.
- Enzymatic fasciotomy: This involves injecting a drug into the affected tissue to break down the collagen, allowing for release of the contracture.
It is important to note that while treatment can improve hand function and reduce symptoms, it is not a cure for Dupuytren's contracture, and the condition can recur over time. Regular monitoring and ongoing management may be necessary to prevent complications and maintain hand function.
Surgery for Dupuytren's Contracture
Dupuytren's contracture is a condition in which the tissue beneath the skin in the palm of the hand becomes thick and tight, causing the fingers to curl inward towards the palm. If the condition progresses and causes significant impairment in hand function, surgery may be necessary.
There are several surgical procedures available to treat Dupuytren's contracture, depending on the severity and location of the contracture. Some of the most common procedures include:
- Fasciectomy: This is the most common surgery for Dupuytren's contracture. It involves removing the thickened tissue from the palm and fingers, which allows the fingers to straighten. The surgeon may perform a partial fasciectomy, which involves removing only the affected tissue, or a complete fasciectomy, which involves removing all the tissue in the palm and fingers.
- Fasciotomy: This procedure involves making a small incision in the palm and cutting the thickened tissue to release the contracture. This procedure is less invasive than a fasciectomy and may be used for less severe cases of Dupuytren's contracture.
- Needle aponeurotomy: This procedure involves inserting a needle into the affected tissue and cutting it to release the contracture. This is a minimally invasive procedure that can be performed under local anesthesia.
The type of surgery recommended will depend on the severity of the condition and the location of the contracture. Recovery time varies depending on the procedure, but most patients can expect to wear a splint or cast for several weeks after surgery and undergo physical therapy to regain hand function. As with any surgery, there are risks associated with Dupuytren's contracture surgery, including infection, bleeding, and nerve damage. It's important to discuss the risks and benefits of surgery with your doctor to determine if it's the right course of treatment for you.
Dupuytren contracture treatment complications
While surgery for Dupuytren's contracture can be effective, like any surgical procedure, it does carry some risks and potential complications. Some possible complications of Dupuytren contracture treatment include:
- Infection: Any surgery carries a risk of infection, and this is no exception. Signs of infection include redness, swelling, pain, and fever. It's important to report any signs of infection to your doctor right away.
- Nerve damage: During surgery, there is a risk of damage to nerves in the hand. This can cause numbness, tingling, or weakness in the affected fingers or hand.
- Bleeding: There is a risk of bleeding during or after the surgery. In some cases, a blood transfusion may be needed.
- Recurrence: Although surgery can correct the contracture, it is possible for it to recur in the same or a different area of the hand.
- Scarring: Surgery can leave scars on the hand. In some cases, the scar tissue can be thick and painful.
- Stiffness: After surgery, the hand may be stiff and difficult to move. Physical therapy can help improve range of motion.
- Complex regional pain syndrome: This is a rare but serious complication that can occur after surgery. It causes severe pain, swelling, and changes in skin temperature and color in the affected limb.
It's important to discuss the potential risks and complications of Dupuytren contracture treatment with your doctor before undergoing any procedure. Your doctor can help you weigh the risks and benefits of each treatment option to determine the best course of action for you.
How can I reduce my risk of developing Dupuytren's contracture?
The exact cause of Dupuytren's contracture is not fully understood, but there are several factors that can increase your risk of developing the condition. While there is no surefire way to prevent Dupuytren's contracture, there are some lifestyle changes that may help reduce your risk or delay its onset. Here are some tips:
- Quit smoking: Smoking has been linked to an increased risk of Dupuytren's contracture, so quitting smoking may help reduce your risk.
- Exercise regularly: Regular exercise can help improve circulation and may help reduce your risk of developing Dupuytren's contracture.
- Maintain a healthy weight: Being overweight or obese has been linked to an increased risk of Dupuytren's contracture, so maintaining a healthy weight may help reduce your risk.
- Eat a healthy diet: A diet rich in fruits, vegetables, whole grains, and lean protein can help reduce inflammation and may help lower your risk of developing Dupuytren's contracture.
- Manage diabetes: If you have diabetes, it's important to manage your blood sugar levels to help reduce your risk of developing Dupuytren's contracture.
- Protect your hands: Avoid repetitive hand movements that can cause strain or injury to the hands. Wear protective gloves when working with tools or machinery.
Life with Dupuytren's Contracture
Living with Dupuytren's contracture can be challenging, especially if the condition progresses and causes significant impairment in hand function. Here are some tips for managing Dupuytren's contracture:
- Stay active: Regular exercise can help maintain mobility and flexibility in the hand and may help slow the progression of the contracture. Talk to your doctor or a physical therapist about exercises that are safe and effective for your condition.
- Adapt to changes: As the contracture progresses, you may need to make adaptations to your daily routine to accommodate changes in hand function. This may include using adaptive devices, such as special grips or utensils, to make tasks easier.
- Seek treatment: If the contracture is causing significant impairment in hand function, surgery may be necessary. Talk to your doctor about the best treatment options for your condition.
- Manage pain: Dupuytren's contracture can cause pain and discomfort. Talk to your doctor about pain management strategies, such as over-the-counter pain relievers or prescription medications.
- Seek support: Living with a chronic condition like Dupuytren's contracture can be challenging. Seek support from family, friends, or a support group to help you cope with the physical and emotional challenges of the condition.
- Stay informed: Keep up-to-date on the latest research and treatment options for Dupuytren's contracture. Talk to your doctor about any new developments that may be relevant to your condition.
Remember, every case of Dupuytren's contracture is different, and what works for one person may not work for another. Work with your doctor to develop a personalized treatment plan that is right for you.
In conclusion, Dupuytren's contracture is a condition that causes the fingers to become bent and contracted, making it difficult to perform everyday tasks. While the exact cause of the condition is not fully understood, there are several risk factors that can increase the likelihood of developing Dupuytren's contracture, such as age, genetics, and certain medical conditions.
Treatment options for Dupuytren's contracture range from non-surgical approaches, such as corticosteroid injections and physical therapy, to surgical interventions, such as fasciectomy or needle aponeurotomy. The best treatment option for each individual depends on the severity of the contracture, the individual's overall health, and other factors.
If you suspect you may have Dupuytren's contracture or have noticed changes in the appearance or function of your hand, it is important to see a doctor for an evaluation. Early diagnosis and treatment can help slow the progression of the condition and improve outcomes.