Dupuytren’s Contracture is a hand condition where thickening of the underlying fibrous tissues of the palm causes the fingers to bend inward. Patients with this condition are unable to fully straighten the affected fingers.
It commonly occurs in the ring finger and little finger. Occasionally the middle finger is affected but the thumb and index finger are rarely affected. Dupuytren’s contracture is a condition that usually progresses slowly over many years and is not usually painful. However, some cases may progress rapidly and be painful to the patient.
Symptoms
The most commonly observed symptoms of Dupuytren’s contracture are lumps or nodules in the palm of the hand, difficulty in straightening the fingers, and contracture of the nodules which form tough bands under the skin and will prevent the fingers from straightening.
Causes and risk factors
The cause of Dupuytren’s contracture is unknown. However, there are certain risk factors that may increase your chance of developing the condition. These can include the following:
- Age: It occurs more frequently around from 50 – 70 years of age. If it occurs earlier it tends to be more severe.
- Social Habits: Smoking and drinking alcohol may increase your risk of developing the condition.
- Medical Conditions: Patients with diabetes, alcoholism, cirrhosis of the liver, and seizure disorders appear to be at increased risk of developing the condition.
- Gender: The condition is more common in males.
- Heredity: The condition tends to run in families.
- Ancestry: Most commonly affected are northern Europeans and people of Scandinavian descent. For this reason, it is sometimes called the “Viking’s Disease”.
Diagnosis
Dupuytren’s contracture is diagnosed based on the patient’s history and physical examination without any special tests required. The physical examination may involve pressing on different parts of your hands and fingers to assess for hardened knots or tough bands of tissue.
Treatment
You may not need treatment for Dupuytren’s contracture if the condition is in the early stages and not affecting your ability to perform daily activities. However, if you are experiencing pain or are having difficulty using your hands for everyday activities, Dr Bala will recommend conservative treatment options to treat your condition. Treatment options will vary depending on the severity of the condition. The conservative approaches include:
- Massage Exercises: Stretching exercises such as bending the fingers away from the palm may provide some comfort, but unlikely to change the natural history.
Other conservative treatment options exist such as needle aponeurotomy and collagenase injections.
Surgical Procedure
If conservative treatment options like needle aponeurotomy or collagenase injections fail to resolve the condition and symptoms persist and your quality of life is adversely affected, Dr Bala may recommend a surgical procedure to release the thickened tissue (Fasciectomy).
This surgery is usually performed in an operating room under regional or general anaesthesia on an outpatient basis as a day surgery. Incisions are made over the affected palm area taking care to raise thick flaps that maintain their blood supply.
The surgeon then removes the thickened fibrous tissue causing the contracture. Often the thickened cords lie very close to the important blood vessels and nerves to each finger. Dr Bala uses special magnification loupes to visualize and protect individual blood vessels and nerves in this region to minimize complications. He is also well trained to repair any such structures that may be damaged inadvertently during this procedure..
Rarely the contracture may be so severe that even after removing the cord the capsule of the joint involved will have to ruptured in a controlled manner to straighten the finger. In very severe contractures it is often not advisable to fully correct the deformity as the blood vessels and nerves that have been contracted for a long time will not tolerate sudden stretching. Sometimes if the skin contracture is severe it may need to be lengthened by a procedure called as Z-plasty after removing the thickened cord to facilitate skin closure. The incision is then closed with sutures and covered with a sterile dressing. Dr Bala tries to preserve the native fortune lines of the palm during suturing for those people who may believe in them. Rarely a plaster will have to be applied at the end of the procedure to maintain the correction of the finger.
Complications
Complications can be medical (general) or specific to hand surgery. Medical complications include those of the anaesthetic and your general well-being. Complications associated with hand surgery include:
- Infection
- Nerve damage causing weakness, paralysis, or loss of feeling in the hand area
- Injury to the arteries of the fingers/hand leading to death of portions of the skin flaps.
- Recurrence of the condition