Dupuytren's Contracture

What is Dupuytren's Contracture?

Dupuytren's contracture is a condition that occurs when the connective tissue in the palm thickens and tightens abnormally, causing the fingers to bend towards the palm and become difficult to straighten. This condition usually starts in the tissue known as the palmar fascia, located just under the skin of the hand. Dupuytren's contracture often begins between the fourth and fifth fingers but can eventually affect other fingers as well.

Dupuytren's contracture typically progresses slowly. Initially, a small nodule or lump may form in the palm, which gradually grows as the tissue thickens. Over time, the fingers begin to curl and can no longer fully straighten. This can limit hand function, making it difficult to perform daily activities.

The exact cause of Dupuytren's contracture is not fully understood, but it is thought to be associated with factors such as genetics, aging, male gender, smoking, alcohol consumption, and certain health conditions. Although it may sometimes be linked to other diseases, most cases have no identifiable cause.

Treatment for Dupuytren's contracture depends on the severity and progression of symptoms. Options may include medication, injections, physical therapy, splints, or surgery. Surgery is typically reserved for cases where symptoms significantly limit function or the fingers become permanently bent. Treatment plans are individualized and should follow the recommendations of a healthcare professional.

Causes of Dupuytren's Contracture

Dupuytren's contracture results from abnormal thickening and tightening of the palmar fascia, but the exact cause is unknown. Possible contributing factors include:

• Genetic Predisposition: Dupuytren's contracture often runs in families, and individuals with a family history are more likely to develop the condition.
• Age: The condition is more common in middle-aged and older individuals as tissue elasticity decreases with age.
• Male Gender: Men are more likely to develop Dupuytren's contracture than women.
• Smoking: Smoking may increase the risk due to tissue damage and impaired circulation.
• Alcohol Consumption: Excessive alcohol intake may contribute to the development of the condition.
• Other Health Conditions: Diseases such as diabetes, liver disease, and epilepsy have been linked to an increased risk of Dupuytren's contracture.

While multiple factors may contribute to Dupuytren's contracture, the specific cause is often unclear.

Symptoms of Dupuytren's Contracture

Symptoms of Dupuytren's contracture include:

• Nodules or Thickened Tissue: Early signs may include lumps or thickened tissue in the palm.
• Curled Fingers: The condition often causes the fourth and fifth fingers to bend.
• Reduced Flexibility: Patients may struggle to straighten their fingers, causing difficulty in daily tasks.
• Sensitivity or Pain in the Palm: As the condition progresses, the palm may become sensitive or painful.
• Functional Limitations: The bent fingers may limit the ability to grip, hold, or perform fine motor tasks.

If you notice these symptoms, consult a healthcare provider for early diagnosis and treatment.

Treatment Options for Dupuytren's Contracture

Treatment varies depending on the severity of the condition and may include:

• Observation: Mild cases may only require monitoring.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or steroid injections may help reduce pain and inflammation.
• Physical Therapy: Exercises can improve flexibility and hand function.
• Splints or Braces: These can help keep fingers straight, especially at night.
• Injections: Collagenase injections can break down thickened tissue.
• Surgery: In severe cases, surgery to remove or release the tightened tissue may be necessary.

Surgery for Dupuytren's Contracture

Surgery may be recommended when other treatments are ineffective. There are several types of surgery, including:

• Fasciectomy: Removal of the thickened tissue.
• Aponeurotomy: Cutting the thickened tissue to release tension.
• Carpal Tunnel Surgery: In more complex cases, this procedure may be performed.

Post-surgery, recovery can take a few weeks, and complications such as infection, tissue damage, and recurrence of contracture are possible, though rare.