Dupuytren's Disease (also called Dupuytren's Contracture) is an inherited disorder, usually in Caucasian males, that causes the fascia on the palm of the hand (and at times, the soles of the feet) to thicken. This thickened fascia can form lumps or nodules under the skin, or long thick cords of tissue that extend from the palm to the fingers. Dupuytren's Disease is sometimes confused with "trigger finger," which is a different condition, characterized by active popping/triggering of the finger/thumb.
What You Need To Know About Dupuytren's Contracture
What is Dupuytren's Contracture?
To understand what Dupuytren's Contracture is, it helps to know what the palmar fascia is and its function in the body. The palmar fascia is a thick layer of tissue beneath the skin on the palm of your hand. Like the foundation of a house, it provides structural support to the hand, helping the skin of your palm stay put. When the palmar fascia begins to thicken and shorten, this is called Dupuytren's Contracture (or Dupuytren's disease).
Dupuytren's Contracture is a disease that progresses slowly. Symptoms usually start with lumps of tissue forming on the palm of your hand, and, as the condition progresses (usually over a period of years), you may see deep, painless dents on the palm.
Eventually, bands of fascia could develop into thicker cords that cause one or more of your fingers, often the ring or little fingers, to bend towards your palm. Imagine how your hand looks when you're holding a soda can. For people with Dupuytren's contracture, it's as if their hand decides to maintain that grip, and they can't fully straighten their fingers. At that stage, hand function is impeded, making it difficult to write, grasp objects, or move your fingers.
You can watch this video to learn more about Dupuytren's Contracture.
What is Dupuytren's Diathesis?
Dupuytren's diathesis is a more advanced form of Dupuytren's contracture. The condition affects both hands, and it is largely hereditary. The disease is associated with other common fascia conditions, including contractures in the feet (Ledderhose's disease) and curvature of the penis (Peyronie's disease).
What Causes Dupuytren's Contracture?
Despite ongoing research, the exact cause of Dupuytren's Contracture remains unclear. It appears that a combination of genetic and environmental factors are involved in its development. There's a notable genetic component to the disease, as it often appears in families, indicating a possible hereditary link. It's also important to note that certain demographic factors seem to influence the prevalence of this condition. Dupuytren's Contracture tends to affect males more frequently, particularly those above the age of 60. Moreover, individuals of Northern European or Scandinavian descent have higher occurrences of this condition.
Several health and lifestyle factors have been identified as potential risk factors, although their role isn't fully understood. For instance, individuals with diabetes or those who take certain seizure medications may have an increased risk of developing Dupuytren's Contracture. Smoking and excessive alcohol consumption have also been associated with the disease, although the nature of these associations isn't definitively clear.
A common belief is that Dupuytren's Contracture develops as a result of overuse of the hand. However, there is no convincing evidence to support this.
Dupuytren's Contracture Symptoms
As Dupuytren's Contracture progresses, you might notice a variety of changes in your hand and how it functions. The symptoms can develop gradually, and they're often easy to overlook at first. Here's what to watch out for:
- The development of one or more firm, painless nodules under the skin of your palm. These are most common along the same line as your ring or little finger.
- Difficulty in laying your hand flat on a table with your palm facing down. This is often referred to as a failed 'tabletop test'.
- The appearance of tender lumps (nodules) in the palm, which over time may lose their tenderness.
- Thickening and tightening of these nodules, leading to the formation of thick bands of tissue under the skin in your palm.
- The development of pits or grooves in the skin caused by the curling of your fingers. These areas can become sore and may lead to skin loss if not properly cared for.
- Fingers that are pulled forward and cannot straighten completely.
- A general decrease in hand functionality due to these physical changes.
Dupuytren's Contracture symptoms can resemble other health problems, which is why it's important to get a proper diagnosis from a healthcare provider.
A crucial thing to remember is that Dupuytren's Contracture typically progresses slowly over several years. While these signs and symptoms may seem minor at first, if you notice persistent changes in the flexibility of your fingers or the appearance of your palm, don't hesitate to seek medical advice. Early consultation can lead to a more proactive management approach and potentially slow the progress of the condition. You should see a doctor if your symptoms start to interfere with your daily activities, such as writing, gripping objects, or even shaking hands.
How is Dupuytren's Contracture Diagnosed?
At Resurgens Orthopaedics, we understand that each patient's journey is unique, which is why we are committed to providing personalized care that suits your specific needs. When it comes to diagnosing conditions like Dupuytren's Contracture, our process is comprehensive and designed to ensure the best possible outcome for you. Here's a step-by-step outline of what you can expect:
Initial Consultation: We begin with a thorough discussion about your general health, medical history, and symptoms. We pay attention to details, so we'd be interested to know if you have any relatives with
Dupuytren's, considering its potential hereditary nature.
Physical Examination: Our skilled physicians will closely examine your hands, focusing on the appearance of your palms, and feel for any hard nodules or thickened bands of tissue. This is often sufficient to
identify the presence of Dupuytren's Contracture.
Table-top Test: As part of the physical exam, we'll perform the 'table-top test'. We'll ask you to place your hand flat on a table. Difficulty in doing so can suggest Dupuytren's Contracture.
Functionality Assessment: We'll also assess the flexibility, sensation, and strength in your fingers and thumb. We measure things like grip and pinch strength to get a comprehensive understanding of your hand's
Documentation: To track the progression of the condition, our team records the locations of nodules and bands on your palm, measures the degree of finger curling or contraction, and evaluates the range of
motion in your fingers. Over time, these measurements will be compared to assess if the disease is progressing and to gauge the effectiveness of your treatment.
Clinical Photography: In some cases, we may take clinical photographs of your hand. These images can provide a useful visual record of the condition's progression over time.
Once a diagnosis of Dupuytren's Contracture is confirmed, we'll discuss your treatment options and recommend a course of action best suited to your case. Your care may involve physical therapy, medication, or in some instances, surgical intervention.
At Resurgens, we're committed to helping you regain and maintain the best possible hand health and functionality.
Dupuytren's Contracture Treatment
When it comes to Dupuytren's Contracture treatment, it largely depends on the severity of the symptoms and the patient's unique circumstances. While there's currently no known cure, there are several effective ways to manage the symptoms and improve hand function.
Non-surgical treatments primarily aim to slow down the progression of the disease and provide relief from discomfort. Here are some common non-surgical approaches:
- Steroid Injections: Steroid injections can be administered in early stages to alleviate pain and potentially slow the progression of the disease. However, these might need to be repeated periodically.
- Collagenase Injections: This newer, less invasive treatment involves injecting an enzyme called collagenase, which weakens the contracted cords, allowing them to be pulled and broken.
- Needle Aponeurotomy: In this procedure, a needle is used to divide the diseased tissue. The procedure is performed under local anesthesia and requires no stitches.
- Radiation Therapy: Although less common in the U.S, this type of treatment involves low energy X-rays are directed at the nodules to soften them and help prevent contractures.
When Dupuytren's Contracture has advanced to the point where hand function is significantly impaired, surgery may be recommended. Known as a limited palmar fasciectomy, this surgery involves removing the thickened fascial tissue. Post-surgery, the hand is typically immobilized for 5-7 days.
Formal hand therapy is usually required post-operation to maximize the recovery of hand function. It's important to note that while these surgical interventions can provide significant relief and improved function, the condition may recur, affecting the same or different fingers.