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Dupuytren's contracture is a fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended (straightened). It is named after the famous surgeon Baron Guillaume Dupuytren, who described an operation to correct the affliction.
The ring finger and pinky finger are the fingers most commonly affected, but Dupuytren's contracture may affect any or all of the fingers. Dupuytren's contracture progresses slowly and is usually painless. In patients with this condition, the tissues under the skin on the palm of the hand thicken and shorten so that the tendons connected to the fingers cannot move freely. The palmar fascia becomes hyperplastic and undergoes contracture. As a result, the affected fingers start to bend more and more and cannot be straightened.
Incidence increases after the age of 40; at this age men are affected more often than women. After the age of 80 the distribution is about even.
Risk Factors
Regular operation of heavy machinery increases one's risk of developing Dupuytren's contracture; family history, diabetes, liver disease, alcoholism, epilepsy and pulmonary tuberculosis are also factors. Surgery of the hand may trigger growth of Dupuytren nodules and cords if an inclination existed before. Dupuytren's contracture may accompany fibrosing syndromes such as Peyronie's disease, Ledderhose's disease and Riedel's struma.
Those of northern european descent are markedly ar risk. Margret Thatcher is perhaps the most famous patient. Interestingly, although this a predominantly caucasian disease, many carribean blacks can present with contractures, and all can trace a distant relative to England or Ireland.
Treatment
- Surgery (in cases of severe contracture removes the contracture)
- Radiation therapy (specifically in early stages inhibits development of contracture)
- Needle aponevrotomy (releases the contracture)
- Triamcinolone (kenalog) injections provide some relief
Surgical management consists of opening the skin over the affected cords of fibrous tissue, and dissecting the fascia away. The tendons can then be brought out to length. The procedure is not curative, and patients may need re-do surgery, however, the thickened fascia often invests the digital nerves and arteries, so there is significant risk of de-vascularization of the digit.
Treatment of Dupuytren's disease with low energy x-rays (radiotherapy) may cure Morbus Dupuytren on a long term, specifically if applied in early stages of the disease. Needle aponevrotomy is a minimal invasive technique where the cords are weakened through the insertion and manipulation of a small needle. Once weakened, the offending cords may be snapped by simply pulling the finger(s) straight. The nodules are not removed and might start growing again. Currently in phase III of Food and Drug Administration (FDA) approval is another promising therapy, the injection of collagenase. This procedure is similar to needle aponevrotomy, however the chords are weakened through the injection of small amounts of an enzyme that dissolves them.
External links
Information on therapies of Dupuytren's disease is also provided on the web site of the Dupuytren society, *.
"Dupuytren's contracture"