Dupuytren’s Contracture can be defined as a deformity that results in thickening of the fascia, a thin elastic tissue under the skin of the palm. The fibrous cords in this tissue develop knots, causing the fingers to bend downwards. In most cases, it is the little and ring finger that gets bent towards the palm. Dupuytren’s Contracture is a progressive disorder that may affect one or both the hands and the symptoms tend to aggravate over the time.
Causes
- Dupuytren’s Contracture is categorized as an idiopathic disorder as the exact cause has not been not clearly identified. However, the following factors may increase an individual’s susceptibility to the condition:
- It could be a genetic trait that
- affects members of the same family
- Men above the age of 50 years are more likely to develop the condition
- Alcohol consumption and smoking are believed to cause changes in the blood vessels that may lead to skin contractures
- Diabetic people are at a greater risk
Symptoms
- Routine activities such as wearing gloves, shaking hands may become difficult
- Visibly deformed fingers as they tend to bend towards the palm
- The lumps of tissues may be visible in the hand and are sensitive when touched
- Pain may or may not be experienced
- Reduced flexibility of the hands and fingers
- The deformity begins with the thickening of the skin of the palm and as it progresses, the palm may appear puckered due to thick knots
- Inability to straighten the hand or grasp objects
- Some patients may develop knots on their knuckles as well as soles of the feet
Diagnosis
- Details of the patient’s family history, medical history and lifestyle may be noted
- The orthopedic doctor may perform a physical evaluation of the hand which includes comparison of both the hands to identify the symptoms and palpation to detect knots or lumps under the skin
- Table top test- The patient may be asked to place his hand flat on the table. Inability to do so confirms the presence of Dupuytren’s Contracture
Treatment
Treatment is aimed at ceasing the progression of the condition and enabling the patient to cope up with the symptoms. These may include:
- Needling technique may be used to puncture the thick tissue cords in the palm. It can be used to pierce more than one finger at the same time as no incision is made
- Splinting may be helpful in straightening the fingers in case of mild contractures
- Surgical release or cutting of the affected tissue that causes bending of the fingers
- Enzymes may be injected into the affected part of the palm to weaken the hard lumps and cords. The fingers are then manipulated to bring them back into their normal position and improve flexibility
- In severe cases, all the tissues from the hand may be surgically removed followed by a skin graft to allow reconstruction of the palm.
- Physical therapy may be recommended post-surgery
- Wearing padded gloves while lifting weights or grasping objects may be helpful
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