A dense layer of tissue called the palmar fascia extends across the palm to the fingers. However, a hand condition known as Dupuytren Contracture can make this band of tissue contract, which can further make the fingers get pulled towards the palm, due to which they may claw. The ring and little fingers are the most commonly affected, but any finger can be affected.
As a contracture worsens, the fascia’s involvement becomes more severe, and the patient struggle with hand function, which can create hindrances in his daily activities.
What is Dupuytren's Contracture?
Dupuytren’s disease, also known as Dupuytren’s contracture, is characterised by an abnormal thickening and tightening of the normally loose and flexible fascia beneath the skin of the palm and fingers. In other words, the person suffering from Dupuytren’s contracture cannot fully extend his ring finger because of the tethering effect of the cord-like structure in the palm. The fascia is made up of strands of fibres that run from the palm upward into the fingers. These cords tighten or contract in Dupuytren’s disease, causing the fingers to curl forward. It can cause crippling hand deformities in severe cases. Dupuytren’s contracture can run in families, implying a genetic predisposition.
The pinkie and ring fingers are the most commonly affected. Both hands are usually affected, though one may exhibit more severe symptoms than the other. The exact cause is unknown, but this hand condition is more common in certain groups like:
- Aged individuals
- Diabetic people
- People with epilepsy undergoing treatment with phenytoins
- People addicted to alcohol
Treatment depends on how severe the condition is, but it may include non-surgical means like corticosteroid injections into the palm or surgical methods.
What could be the possible causes of Dupuytren's Contracture?
It is unknown what causes the palmar fascia to thicken and contract. Manual labour with vibration exposure, prior hand trauma, smoking, hyperlipidemia, Peyronie disease, and complex regional pain syndrome are all potential risk factors (CRPS). There is frequently a family history of the condition.
Other factors that may play a role include:
- Age – This nerve problem in hands is more prevalent in the middle to late life.
- Gender – Males are three times more prone to develop this hand ailment and are more likely to develop an acute condition.
- Ancestry – Those with Celtic or Scandinavian ancestry are more vulnerable.
- Underlying health conditions – People with diabetes or epilepsy have a higher incidence of the condition, whereas those with rheumatoid arthritis have a lower incidence.
- Alcoholism – Contracture is more common in alcoholics, and it is more severe.
What are the symptoms of Dupuytren's Contracture?
- On the palm, a lump or nodule appears, usually near the base of the ring or little finger.
- There appears to be a thickened cord running from the palm to the fingers.
- As the contracture progresses, the fingers become clawed as they are drawn toward the palm.
- The hand makes a bow.
- The fingers are firmly gripped against the palm.
- Palm skin is frequently dimpled and puckered.
- There is almost no associated pain.
What are the options for Dupuytren's Contracture treatment?
The severity of the condition determines treatment. In the early stages, treatment may include corticosteroid injections into the fascia. These medications alleviate any localised tenderness and may help to delay subsequent tissue thickening.
Another excellent treatment is low-dose radiation therapy. It should be considered especially in phases with activity. Recent promising treatments include calcium channel blocker therapy, and gamma-interferon therapy.
In severe or advanced cases, the individual is unable to lay their hand palm-down on a flat surface, or their fingers have contracted into their palm, rendering the hand inoperable. The best option is then surgery. Dupuytren’s contracture may reappear after surgery, either at the same location or elsewhere on the palm.
Depending on the severity of the condition, surgery options may include:
- Cutting the fascia bands through small incisions in the palm, removing the thickened fascia, or a combination of the two.
- Removing the fascia and associated skin, and sealing the palm with a skin graft.
- Affected finger amputation if the contracture has returned so many times that corrective surgery is no longer possible.
There are majorly two types of surgical procedures in the case of Dupuytren’s Contracture:
Fasciotomy – Our hand specialist will make an incision in your palm and divide the thickened cord(s) of tissue during this procedure. Although the cord is not cut, dividing it aids in reducing contracture and increasing movement of the affected finger.
Subtotal palmar fasciectomy – Your doctor will make an incision and then remove as much of the abnormal tissue and cord(s) as possible to straighten your finger (s). Fasciotomy is a less invasive procedure than subtotal palmar fasciectomy. It usually entails more wound care and physical therapy, as well as a longer healing time and more patient effort during recovery.
Consult our hand expert and surgeon in Dubai
Prof. Dr Robert Hierner has vast experience of more than 30 years and is specialised in interdisciplinary treatment. His area of expertise is a combination of physiotherapy, neurology, rheumatology, radiotherapy, anaesthesia, and hand surgery to provide the best possible care for the affected hand.
Along with providing accurate lines of treatment for Dupuytren’s Contracture, he also offers effective treats hand conditions like ageing hands, rheumatoid hands, congenital malformations, trauma, and tumours.
Book your appointment to get a detailed diagnosis.