Dupuytren contracture is an abnormal thickening of the fascia in the palm of the hand, present below the skin and sub-cutaneous fat.
This thickened area may develop into cords or thick bands. Over time, it can cause one or more fingers to curl (contract), or pull sideways or in toward your palm with the inability to completely straighten the fingers.
The ring and little fingers are most commonly affected. In many cases, it affects both hands. Rarely, feet may also be affected.
What causes Dupuytren’s contracture?
Dupuytren’s contracture is believed to run in families (be hereditary). The exact cause is not known.
It may be linked to cigarette smoking, alcoholism, diabetes, tuberculosis,, or medicines used to treat seizures.
Who is at risk for Dupuytren's contracture?
You may be at greater risk for Dupuytren contracture if you are:
- Older: The condition usually starts in middle age.
- Male: It is more common in men than women.
- Have a Scandinavian or Northern European background: It is most common in people whose families come from these regions.
- Have a family history: The condition is often found in families, so it may be inherited.
- Take seizure medicine: It is linked with some medicines used to treat epileptic seizures.
- Smoke or abuse alcohol
- Have diabetes
What are the symptoms of Dupuytren contracture?
Common symptoms may include:
- Not being able to lay your hand flat on a table, palm down (called the tabletop test)
- One or more small, sore lumps (nodules) in the palm. Over time, the soreness usually goes away.
- The nodules may thicken and contract or tighten. This can cause thick bands of tissue under the skin in the palm of the hand.
- Pits or grooves in the skin compressed by the contracted finger. These areas can become very sore and can lead to skin loss if they don’t heal well.
- Fingers are pulled forward
How is Dupuytren contracture diagnosed?
It's a clinical diagnosis, just the look of it says it all. It does not need any specific test to confirm the diagnosis
Treatment for Dupuytren’s Contracture
Treatment for Dupuytren’s contracture is SURGERY
Surgery involves the removal of the thickened bands and cord which run along the nerves and blood vessels of the finger. They have to be removed with due care ensuring that no vital structures are damaged.
In addition, in severe contractures, skin grafts or small flaps may be required due to the adherence of skin to the underlying bands.
- Needle aponeurotomy:
This is another newer, less invasive procedure. Medicine is injected into the area to numb the hand. The surgeon uses a needle to divide the diseased tissue. No incision is made. This may be useful only in mild cases and there is a chance of recurrence with this.
Dressings and plaster will be there for a week to ten days.
Gentle finger exercises will be started in one or two days after surgery.
The patient will need to steadily improve the range of finger movements to get the full benefit of the surgery.
Night splinting may be advised for 2-3 months after surgery.