Dupuytren Contracture

A painless ailment called Dupuytren Contracture causes one or more fingers to bend inward towards the hand's palm. The damaged fingers are unable to fully straighten.

Tissue gathers into knots beneath the skin. They ultimately develop a thick chord that can bend the fingers. With time, the situation progressively grows worse.

The two fingers furthest from the thumb are most frequently affected by Dupuytren contracture. This might make simple tasks more difficult, such as putting your hands in your pockets, donning gloves, or shaking hands. Dupuytren contracture cannot be cured. Therapies can lessen symptoms and delay the rate at which the illness deteriorates.

Dupuytren Contracture: Causes

It is uncertain what causes Dupuytren contracture. The disorder typically runs in families. Men experience it more frequently than women.

Dupuytren Contracture: Symptoms

A palpable lump in the palm—typically in the distal palmar crease—marks the beginning of Dupuytren disease. Early in the condition, individuals may just have palpable cords down the palm as the nodules expand into cords. The cords induce permanent flexion contractures of the fingers at the MCP and PIP joints as they become thicker and become shorter. Patients often arrive at this stage with reduced hand range of motion and palpable cables in the palm that extends into the afflicted fingers. Pathognomonic features of Dupuytren disease include nodules, cords, and finger contractures. Patients seldom ever express pain.

The most often impacted digit is the fourth, followed by the fifth. The severity of the illness may not always be symmetrical, even when it is bilateral. Unless the ulnar nerve is constricted, the nodules often do not hurt to the touch. In addition, tenosynovitis may cause the nodules to become painful.

Physical Findings

• When the finger is stretched, the skin turns white.

• The cables are painless close to the nodules.

• There might be grooves and pits.

• The PIP joints' knuckle pads might be sore.

• When the plantar fascia is affected, the condition is more severe (Ledderhose disease)

• The patient is asked to try to lay their hand flat on the examination table as part of the tabletop test (Hueston). A positive test would come from the patient being unable to straighten their fingers due to any flexion contracture deformity.

Dupuytren Contracture: Risk Factors

Several factors play an important role in the development of Dupuytren contracture which include −

• Age. Beyond age 50, Dupuytren contracture most frequently develops.

• Sex. Dupuytren is far more common in men than in women. Men may experience harsher symptoms and a faster rate of progression.

• Ancestry. Those of Northern European ancestry are more susceptible to contracting the illness.

• Family background. Oftentimes, Dupuytren contracture runs in families.

• Occupation. According to certain research, those who use vibrating instruments at work are more likely to develop Dupuytren contracture.

• Diabetes. Diabetes increases a person's chance of developing Dupuytren contracture.

• Alcohol and tobacco usage. Both alcohol use and cigarette use raise the risk of Dupuytren contracture.

Dupuytren Contracture: Diagnosis

The diagnosis of the Dupuytren contracture is mainly done based on history and some of the tests may be required for confirmation and to rule out underlying causes

The hands' appearance and texture may often be used to identify Dupuytren contracture. Rarely is further testing necessary. Healthcare professionals contrast the hands with one another and look for palm skin puckering. Also, they apply pressure to specific areas of the hands and fingers to feel for tissue bands or hard knots.

Placing the hand's palm flat on a tabletop or other flat surface is another way to check for Dupuytren contracture. Your fingers might need to be treated if you can't entirely flatten them.

Dupuytren Contracture: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

Conservative Treatment

For people with painless, stable illnesses and no functional impairment, observation is suitable. To monitor the development of the condition, follow-up exams may be given every six months.

When the illness is still in its early stages, the physical and occupational treatment that uses heat and ultrasonic waves can be beneficial. A brace or splint may also help some individuals lengthen their digits. To avoid adhesions, the fingers' range of motion is essential.

Injections of corticosteroids may be advantageous for certain individuals, particularly those with painful nodules. Sadly, not all patients respond to steroid injections, and recurrence rates of up to 50% have been documented. More importantly, corticosteroid injections have the potential to induce tendon rupture as well as fat atrophy and pigmentation changes.

Tamoxifen, anti-tumor necrosis factor drugs, 5 fluorouracil, imiquimod, and botulinum toxin are some other therapies that have been tested. There is no proof that any of these therapies are better than the others or that they will help everyone.

Radiation therapy has a substantial number of side effects and may only be effective in the early stages of the disease.

Surgical Treatment

Both partial and complete surgical fasciotomies are possible. A partial palmar fasciectomy involves only a little amount of diseased tissue being removed from a ray. The spinal cord is typically encountered after dissecting proximal to distal, which typically enables the identification of neurovascular structures. A Brunner zigzag pattern is used to create incisions that are unique to each patient. The constricted skin can also be lengthened using a Z-plasty and a V-Y incision. It is important to protect the neurovascular bundles.

Although surgery may be done, total palmar fasciectomy—which necessitates removing all of the palmar and digital fascia, including healthy tissue—is rarely employed. Chronic digital cords, infiltrating disease, or recurrence following a partial surgical operation are all indications of it.

Skin necrosis, hematoma (the most frequent consequence), flare response, neurovascular damage, digital ischemia, edema, and infection are complications of fasciotomies.

Dupuytren Contracture: Prevention

Some of the measures that can help to prevent Dupuytren contracture include −

• Lessen your palm pressure

• Do some exercise and use a massage

• Eat a Balanced Diet

• Minimize drinking

• Give up smoking

• Take supplements

Conclusion

An interprofessional team, which may include a dermatologist, orthopedic/hand surgeon, hand therapist, and the patient's primary care physician, manages Dupuytren contracture in patients. There are many different types of treatments available. Using open procedures, diseased tissue may be removed more thoroughly while important neurovascular systems can be seen clearly.

Although injection-based treatment is less intrusive, there is a higher risk of injury to nearby tissues and an incomplete release of contractures. The likelihood of the illness returning is significant with non-operative and injection-based treatments, while it occurs with all therapies as well.

These patients' primary care physician and the treating surgeon typically follow up with them. The patient's primary care physician can support them in managing their blood sugar, cutting back on alcohol use, and quitting smoking. All therapies have possible side effects, thus only symptomatic individuals with restrictions in motion should be treated. The healthcare team must communicate effectively if the results are to be improved. To cure this condition and restore mobility, hand therapists are essential.