Dupuytrens contracture is a deformity of the hand that can lead to a significant amount of limited function. How does this condition occur? What kinds of treatments are available to treat this condition and is surgery always necessary?
The hand is a complicated structure comprised of bones, ligaments, and tendons. In the palm of the hand is a broad band of fascia, called the palmar fascia, which functions to help support the ability of the hand to grip.
The fascia of the hand attaches to both the skin above and bones below. This fascia functions as a means of limiting the the amount of skin movement as gripping is performed.
What is Dupuytrens?
Dupuytrens contracture is a thickening of this palmar fascia of the hand. This thickening generally occurs over time and is not painful.
Most often the contracture begins as a lump or a dimple in the hand near the base of the middle or ring finger. As the condition progresses, the band that is formed crosses the joint, limiting the ability of the fingers to extend. The ring and pinky fingers are most often affected.
As the ability to straighten the fingers reduces over time activities such as shaking hands, washing hands, putting the hands in the pockets, and getting gloves on and off becomes cumbersome. The progression of the contracture can take years to develop.
This disease is different than
in that Dupuytrens contracture involves the fascia and not the flexor tendons of the hand.
Who Develops Dupuytrens?
Dupuytrens is most common in those of Northern European or Scandinavia descent. Males are eight to ten times more likely to develop Dupuytrens than females, specifically at an earlier age.
Most commonly the deformity begins from age 40-60 with more aggressive forms occurring at an earlier age. There also appears to be a genetic component to developing Dupuytrens as most that develop the condition have a family history.
There is no known cause for why this condition develops. There is some evidence that it may be related to alcohol consumption, diabetes, and even seizures. It has not been related to any type of injury.
Dupuytrens itself cannot be cured. Rather, treatment is based on the severity of the condition with the goal of improving function as opposed to halting the disease. Many do not need to seek treatment at all as the progression of the disease is slow and does not limit function.
The use of a steroid injection is sometimes utilized if the lumps or nodules are painful. Injections, splinting, and aggressive stretching have not been shown to be beneficial in improving tissue mobility.
Surgery is a common treatment option with the goal of the surgery to remove the fibrotic tissue. Therapy involving stretching and splinting are used to help improve the mobility of the tissue following surgery.
A less invasive technique called needle aponeurotomy has also been utilized. This treatment involves utilizing small needles to weaken the fibrotic tissue, allowing it to become more flexible. As with surgery it is followed by therapy to maximize the mobility gained.
Unfortunately, because surgery and needle aponeurotomy addresses improving function and cannot cure the condition, reoccurance occurs in 20% of those having surgery.
It is important following any procedure for the treatment of dupuytrens contracture that physical therapy be part of the post operative process. Both static and dynamic splinting may be utilized to help maintain gained range of motion in addition to traditional stretching exercises.
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