Dupuytren's disease

Dupuytren's contracture is a hand disorder affecting the palmar tendon. The disease is characteristic of northern Europeans. It occurs twice as often in men as in women, usually after the age of 40. In men, the contracture is usually more advanced. It mostly involves the ring finger and little finger. It can affect both hands. Without proper treatment, the fingers may remain in flexion already permanently, making it difficult to perform daily activities.

What are the causes of Dupuytren's Disease?

Dupuytren's disease is a condition that mainly affects the hands and fingers. The cause of the contracture is hypertrophy of fibroblasts of the palmar tendon and deposition of collagen in it. Dupuytren's contracture is inherited autosomal dominantly, with different gene penetrance. People with families that have had the condition have a higher risk of developing it. It can also be an occupational injury, so exposures to overload and micro-injuries during work can cause small bleeding hemorrhages into the tendon and be the beginning of the fibrotic process.

Risk factors for Dupuytren's Disease:

• men are at higher risk for Dupuytren's disease than women,
• people with families that have had the disease have a higher risk of developing it,
• Ethnicity of northern Europeans, especially Scandinavians,
• the risk of Dupuytren's disease increases with age, especially after the age of 40,
• smoking and alcohol abuse can contribute to the development of the disease,
• chronic diseases like diabetes, epilepsy and liver disease can increase the risk of developing Dupuytren's contracture,
• occupational work, especially with mechanical tools (prolonged vibration) can lead to hand injuries that increase the risk of Dupuytren's disease.

Symptoms of Dupuytren's disease

• The disease manifests itself in various ways; initially, there may be only thickened nodules on the hand and fingers. They are usually small and may be felt as slightly thickened tissue. The skin over the thickenings may look tightened or wrinkled.
• Over time, the progression of the disease can lead to the formation of striated Dupuytren's tissue, which encompasses, the finger restricts the extension of the metacarpophalangeal and interphalangeal joints, causing contracture. As the disease progresses, the fingers (often the little finger and ring finger) may become less mobile.
• A characteristic symptom of Dupuytren's disease is a gradual bending of the fingers toward the hand. In advanced cases, the fingers may be so bent that straightening them becomes impossible. Lesions can occur in one or both hands, but usually do not develop symmetrically.
• In advanced stages, the disease significantly limits the function of the hand and makes it difficult, for example, to write, hold objects, put on gloves, put a hand in a pocket or say hello.
• Although Dupuytren's disease is often not painful, some patients may experience discomfort or pain, especially in the early stages.

Medical examination

Diagnosis of Dupuytren's contracture is based primarily on a clinical examination, which is carried out by a hand surgeon. The medical history is very important here. Since Dupuytren's disease can be familial, the doctor may ask whether anyone among relatives has suffered from the disease. The doctor will then examine the hand and fingers, assessing the location of the nodules, measure the range of motion and sensation in the fingers. An ultrasound may also be helpful in the diagnosis to confirm the diagnosis.

Treatment of Dupuytren's disease

Minor lesions without restriction of finger movement do not require surgical treatment. Periodic check-ups with an orthopedic doctor - a hand surgeon - are then indicated. At an earlier stage of the disease, the doctor may decide to inject steroid drugs. Corticosteroid injections can be used to reduce inflammation and slow the progression of the disease, especially for painful nodules. Another form of treatment is collagenase injections. Injection of the drug can lead to weakening of the contracture.

Surgical treatment

Dupuytren's disease often develops over several years - it is characterized by a slow progression of changes. Unfortunately, by the time the patient reaches a specialist hand surgeon, then only surgical treatment is needed.Most patients opt for surgical treatment because of discomfort, pain or contracture of the fingers, which will make it difficult to perform daily activities. There are many surgical methods adapted to the form and severity of the disease. Minimally invasive surgery may involve the subcutaneous cutting of a single contracture band to release the contracture. Open surgery is indicated for more extensive disease. It involves complete excision of the altered palmar cleft and nodules with simultaneous correction of the contracture of the fingers. Due to the extent of the surgical cuts and the wound drains placed, a one-day hospitalization is sometimes required. Postoperative kinesitherapy includes exercises to improve the hand.

Dupuytren's disease - rehabilitation

If your Dupuytren's disease is not severe, does not limit your ability to perform the simplest of activities and thus does not qualify you for surgery, visit Rehasport for a physiotherapy consultation to learn how to prevent the disease from progressing.

Related Articles:

Learn about other possible hand and wrist injuries.

Bibliography:

• Ortho Bullets - Dupuytren's Disease - Brian Weatherford MD
• OrthoInfo - Dupuytren's Disease - Carlton M. Clinkscales, MD
• National Library of Medicine - Dupuytren Contracture - Joel Walthall; Prashanth Anand; Uzma H. Rehman.
• EPIDEMIOLOGY OF DUPUYTREN’S DISEASE - Douglas C.Ross MD, FRCSC - Hand Clinics Volume 15, Issue 1, February 1999, Pages 53-62
• Emedicine – Dupuytren Contracture Eva Kovacs, MD