What Is Dupuytren's Contracture?

What Is Dupuytren's Contracture?
Dupuytren's Contracture - A painless thickening of the connective
tissue in the palmar hand that can lead to difficulty extending the
digits. Causes include hand trauma and genetic predisposition. Features
include a painless nodule on the palm, cord-like bands across the palm,
thickening of the lines of the palm, and curling (contracture) of the
4th and 5th digits. Surgery is performed in some cases unresponsive to
conservative measures (splinting, warm soaks, exercises).

It is a very common problem and often arises in the hands of middle
aged persons; however, it can be seen as early as the twenties. This
entity does run in families in some cases. It is seven times more
common in men than women. It has been associated with diabetes and can
be seen in alcoholics with cirrhosis of the liver. It has also been
associated with epilepsy but may be a result of the use of
anticonvulsant drugs rather than the presence of epilepsy itself. The
underlying cause is unknown.

The patient usually first notices a painless small hard lump below
the skin in the mid palm at the base of the ring or little finger. As
the disease progresses, the overlying skin becomes increasingly
puckered and rough bands of thickened tissue can be felt over the
affected area. The first and second joints of the affected finger
eventually become pulled down from the thickening and contracture of
the tissue. The distal (farthest from the palm) joint remains
unaffected. The joints themselves remain unaffected, but in
long-standing cases the joints can become stiff from limited motion.
The severity of the contracture varies from patient to patient and even
in the same patient as the disease may progress. In more severe cases,
the middle, index, and long fingers and even the thumb can become
affected. The patient may notice thickening over the dorsal (back) side
of the finger joints (termed knuckle pads). If the patient's feet are
involved, this usually takes the form of of a firm nodule under the
instep of the foot.

Some conservative methods have been investigated for the treatment
of Dupuytren's contracture. These include among others, physical
therapy, needle fasciotomy, dimethyl sulfoxide, vitamin E (200-2,000
IU/day for several months may be helpful), ultrasound therapy, steroid
injection, and splinting. Most of these therapies have not proven to be
clinically useful. For an accurately diagnosed case of Dupuytren?s
contracture, the only successful treatment to date is surgery.

However, if the patient's condition is stable and the disease is not
progressing, then the risks of surgery must be weighed against the
actual decrease in the patient's quality of life due to the disease,
especially in elderly patients. The patient is instructed to use heat,
perform stretching exercises, and massage the palm for early treatment,
in an attempt to maintain flexibility and function. Once significant
functional loss has occurred, surgical treatment is justified. If only
one area of the palm is involved and only one scarred band is present,
then the surgeon may be able to only cut this band for relief of the
contracture. This procedure is simple, but the disease has a high rate
of recurrence. However, if the problem is more extensive, then the only
effective option is to surgically remove the diseased fascia
(fasciectomy). This will only solve the problem in the area removed;
patients with this condition are more likely to have the condition
arise in other areas, especially if there is a hereditary component to
the patient's condition.