Dupuytren's contracture

dupuytren s contracture

 

Increasing the thickness of the palmar fascia (a layer just below the skin of the palm wrapped around the muscle, nerve and vascular structure of the hand) makes some thick band that will gradually bend the fingers. The affected fingers will bend towards the palm of the hand and as the disease progress, these fingers may fail to open completely anymore. This disease is called 'Dupuytren contracture'. What you will read next:

 

What is palmar fascia?

How does a Dupuytren Contracture develop?

What are the risk factors for Dupuytren Contracture?

What are the symptoms of Dupuytren Contracture?

What are the main principles of diagnosis?

Treatment of Dupuytren Contracture

Post-surgery care for Dupuytren Contracture

 

 

 

What is palmar fascia?

Under the skin of the palm is a solid membrane called the palmar fascia, which has a triangle-like shape whose base is adjacent to the base of the fingers. The tendons that bend our fingers toward the palm of the hand are adjacent to the plantar fascia or palmar fascia.

 

How is a Dupuytren contracture created?

The exact cause of the Dupuytren contracture is unknown yet. In some people, for no apparent reason, part of this membrane or fascia thickens. As the thickness increases, the area of ​​the curtain shrinks and becomes shorter. When the curtain is shortened, one or more fingers bend towards the palm of the hand and remain bent.

In non-diabetics, the most common fingers involved are the fourth and the fifth fingers (where the smallest finger numbered 5th and the adjacent one numbered 4th). For this disease, men are more likely to get involved than women.

In people with diabetes, fingers three and four are more common to get involved, and diabetic women are more likely to develop Dupuytren contraction than diabetic men.

 

What are the risk factors for Dupuytren contracture?

Having the following characteristics and factors makes a person prone to this disease:

  • Genetic factors
  • Have a history of wrist fractures
  • Being masculine
  • smoking
  • Long-term diabetes
  • AIDS
  • Alcohol consumption
  • Jobs and activities that involve repeated pressure on the palm of the hand.

The deposition of collagen type one and three (a protein that is present in the environment outside the cells and act as woven band to hold the structures together) can increase the thickness of the palmar fascia.

 

What are the main symptoms of Dupuytren contracture?

Dupuytren's contraction is usually gradual, progressing painlessly for a long time. Over time, thick bands form on the palm, the skin tightens and becomes thicker, and finally lumpy knots form on the palm. Consequently, the range of motion of the finger gets limited and the efficiency of the hand decreases.

There may be pain in some stages, but overall, even in advanced stages, the hand will not be painful. However, bruising of the fingertips because of long-term friction to the hand's palmar surface can occur due to the inability of fingers to open sufficiently.

 

What are the principles of diagnosis of Dupuytren contracture?

Dupuytren contracture diagnosis is not particularly challenging and is usually done by your physician examining your hand and taking some tests. you physician may do the following before deciding about the proper treatment:

  • Chief complaint (CC)
  • Clinical examination
  • Thyroid function test
  • Blood glucose and hemoglobin A1C tests (A1C hemoglobin test is a common blood test that is effective in screening diabetics. It also shows how well the patient has been successful in controlling diabetes)

Note: If a progressive palm mass is seen in a young non-diabetic patients, it is best to have a biopsy to rule out sarcoma (any group of malignant tumors that target mesoderm-based cells or connective tissue).

In some men, the skin on the soles of the feet or the penis undergoes similar changes.

 

Treatments for Dupuytren contracture

  1. Non-surgical treatment
  2. Surgical treatment

Non-surgical treatments:

  • Topical corticosteroid injection:

In cases where the severity of the disease is low, pain can be reduced by injecting steroids into the developed masses. These injections can also prevent the disease from progressing.

  • Oral anti-inflammatory drugs
  • Splints
  • Physiotherapy
  • Prolotherapy (topical and outpatient injections) like PRP (plasma containing concentrated platelets)
  • Ultrasound therapy

 

Surgical treatment:

In advanced cases of Dupuytren contracture where the function of the hand has decreased, the physician may recommend surgery.

It is said that surgery would be necessary if the patient could not put his palm on a flat surface. During the surgery, the surgeon removes part of the thickened tissue.

 

Care after Dupuytren contracture surgery:

You will have swollen hands after surgery and should:

  • Hold your hand up
  • Start your limited movements gradually
  • Finger movements and strengthening the muscles of the hands and fingers are especially important.
  • Perform physiotherapy sessions if necessary
  • The patient usually uses a splint six weeks after surgery. Sometimes it is recommended that the patient use the splint at night for another six months.
  • In cases where the disease recurs, limited re-surgery is sometimes necessary.
  • Complications of surgery include stiff hands and fingers.

 

 

 

 

Address: 393 University Avenue,Suite 200,Toronto ON MG5 2M2,CANADA

Email: info@MarsoClinic.com

Phone: +1(647)303 0740

All Rights Reserved © By MarsoClinic

Terms of Use