Description
Dupuytren's contracture is a condition that affects the palmar fascia. The palmar fascia is a thick tissue that lies above the tendons and below the skin of the hand. The fascia is attached both to the skin above and to structures below. Through these attachments the palmar fascia acts as an anchor to enhance the grip ability of the hand. With Dupuytren's, the fascia becomes diseased and thickened, which leads to finger contractures. Because of the contractures, the fingers can become permanently flexed and the function of the hand is impaired.
Symptoms
A Dupuytren's contracture typically progresses slowly, over a period of years. Signs and symptoms of the condition may include:
- Nodules: One or more small lumps, or nodules, in the palm of your hand. Early on, the nodules may feel tender but this tenderness usually goes away over time.
- Cords: Dense and tough cords of tissue under the skin may form as a result of the thickening nodules. These cords can restrict movement of the fingers and thumb, making it difficult to straight or spread them apart.
- Contractures: Tissue tightening causes one or more of the fingers to be pulled towards the palm, restricting them from straightening or spreading apart. Dupuytren’s most commonly affects the first joint (knuckle) of the ring and little fingers, however, any finger or finger joint can be involved.
Tightening of the tissue causes the fingers to bend and remain in a fixed position. As the contracture worsens, straightening of the fingers, grasping large objects, putting your hand in your pocket, or performing other simple tasks may become more difficult.
Causes
- The cause of Dupuytren's disease is not completely known, but most evidence has found genetics as having the most important role. Although there is lacking evidence, other believed causes are injury or an open wound to the hand (including surgery) and overuse of the hand
Prevention
- There are no common preventative measures as genetics play the greatest role in causing the condition however, proper care of hand injuries and wounds, and avoiding repetitive use of the hand is recommended.
Risk Factors
- Gender: More common in men
- Ancestry: People of northern European (English, Irish, Scottish, French, and Dutch) and Scandinavian (Swedish, Norwegian, and Finnish) ancestry.
- Heredity
- Alcohol use
- Certain medical conditions: Diabetes and seizure disorders.
- Age: The incidence of Dupuytren’s increases with age.
Diagnosis
A doctor will discuss your symptoms, review your personal and family’s medical history, and complete a thorough physical examination of your fingers and hand.
During the physical exam, he or she may
- Record the number of nodules present in the hand and their location
- Assess the range of motion of the fingers
- Assess the strength of your hand and fingers with grip testing
Treatment
- There is no effective means by which the course of Dupuytren’s disease can be altered, so the early, nodular stages are usually a case of observation only. Patients are generally seen by a physician every few months to monitor the extent of the condition.
- There is no cure for Dupuytren’s disease, however, standard treatments include a fasciotomy or minimally invasive needle aponeurotomy.
