Dupuytren Contracture

What is Dupuytren contracture?

Dupuytren contracture, also known as Dupuytren disease, is a hereditary condition that causes thickening and tightening of the tissue underneath the skin of the palms and hands. Nodules or small bumps form on the fascia, which is a tissue resembling a rubber band beneath the skin supporting fingers and hand. These growths might eventually develop into thick nodes under the skin, causing fingers to bend such that straightening them becomes very difficult.

The growths causing Dupuytren contracture are usually benign, meaning they are not a cause or symptom of cancer. While surgery may be required, most cases are manageable with conventional treatments.

What are The Symptoms of Dupuytren Contracture?

It can take several months to years for Dupuytren contracture to develop. Therefore, symptoms may go unnoticed at first and later emerge in these stages:

• Nodules: The initial Dupuytren contracture sign is small bumps beneath the skin on the palm, typically at the base of fingers joining the palm. These nodules, which may be visible or can be felt, can make the surrounding skin appear puckered or dimpled. However, some individuals only develop nodules without other symptoms and may eventually disappear on their own.

• Cords: The nodules might thicken to form long tissue cords on the fascia with time. These cords may constantly feel as if they are pulling the fingers towards the palm.
• Contracture: This is the most advanced sign, hence the name Dupuytren contracture. The cords may eventually thicken and tighten, making it almost impossible to straighten or stretch the affected fingers from the palm.

Usually, there are no triggers worsening the symptoms of Dupuytren contracture like in other conditions. Instead, the symptoms may gradually aggravate with time as nodules develop into cords, potentially causing contracture. However, not all people experience every stages of symptoms.

Additional symptoms

Apart from the problems with the fingers, these symptoms may also occur on the affected hand:

• Swelling or inflammation

• Tenderness

• Itching

• Pain or burning

These Dupuytren contracture symptoms are usually uncommon and affect only about a quarter of individuals with the condition. If you have the disorder and experience any of these signs, consult a doctor right away, as they may indicate other problems affecting your fascia or skin.

What Causes Dupuytren Contracture?

Although scientists are not certain of the cause, Dupuytren contracture is considered a hereditary disorder. This is because there are increased chances of developing the condition if a close family member has had it. For that reason, Dupuytren contracture is the most prevalent inherited condition affecting connective tissues.

Who is at risk for Dupuytren contracture?

Some of the risk factors that increase the chances of developing Dupuytren contracture are:

• Age: Dupuytren contracture is more common in middle-aged people.
• Gender: Men are usually more affected compared to women.
• Ethnicity: There are higher occurrence rates in people with families from Scandinavian or Northern European background.
• Family history: The disorder usually affects families; hence,it can be hereditary.
• Medication: Epileptic seizure drugs have been connected with Dupuytren contracture.
• Diabetes: Having diabetes increases the risk of Dupuytren contracture.
• Smoking or alcohol abuse: This has also been linked with higher risks of Dupuytren contracture.

How is Dupuytren Contracture Diagnosed?

Dupuytren contracture diagnosis involves a physical examination of the hand. The medical provider will check your fingers and hand, palpate for nodules and cords beneath the skin, and assess the severity of contracture.

Which tests are to diagnose Dupuytren contracture?

No specific tests are required for Dupuytren contracture diagnosis. However, the healthcare provider can ask for blood tests or X-rays to look for other possible problems affecting your hands.

How is Dupuytren Contracture Treated?

Treatment of Dupuytren contracture involves numerous stages based on the severity of the symptoms. Since the condition advances gradually, it may take several months to years before undergoing the next treatment level. Also, the symptoms could go away with initial treatment; hence, additional options won’t be required. But if the early signs recur, you might have to repeat certain treatment steps.

Conservative treatment

Dupuytren contracture conservative treatment options are:

• Physical therapies or stretching workouts.

• Splinting or bracing to help stretch fingers to their normal movement range or how far they can move.

• Ultrasonic (painless sound waves) or heat treatments to boost the flexibility of the fascia.

• Corticosteroid injections to help constrict nodules and cords.

Radiation therapy

You may be referred to a radiation professional to assist in addressing Dupuytren contracture or to inhibit the progression of symptoms. The procedure is usually painless and involves focusing X-rays or other beams on the nodules or cords to make them soft.

Radiation therapy is a treatment option for some forms of cancer. However, Dupuytren contracture is not cancerous, and having the condition does not signify that you have cancer or it will develop later.

Needle aponeurotomy

For symptoms that fail to improve after several months of conservative treatment, the doctor can suggest a needle aponeurotomy. Also referred to as percutaneous needle fasciotomy, this treatment is an outpatient and can be done at the provider’s office.

During the procedure, your hand will be numbed with a local anaesthetic. Holes are then poked on the fascia using a needle to relieve tension and straighten the fingers.

Collagenase injections

Collagenase, an enzyme loosening and breaking down growths of fascia, might be injected into the nodules or cords to address Dupuytren contracture. During the procedure, collagenase is first injected directly into the nodules or cords. After that, you will return the next day and your hand will be numbed and the affected fingers stretched back to the normal motion range.

Dupuytren contracture surgery

For severe contracture cases interrupting a person’s quality of life, surgery may be needed. Dupuytren contracture surgery is usually outpatient, meaning you can return home on that same day.

The surgeon will perform a fasciectomy, which involves numbing the hand using local anaesthetic and removing all or some of the affected fascia. The amount to be removed will depend on the extent of fascia thickening and the severity of the contracture. Physical or occupational therapy following surgery may be necessary to help regain joint strength.

When Should I See My Healthcare Provider?

See your medical provider if your symptoms are progressively worsening. Seeking early treatment increases the chances of relieving symptoms before advancing further.

The ideal way of monitoring symptom progression is using a tabletop test, which involves placing your hand on a flat surface with your palm facing downwards. So if the affected fingers do not lie flat, then there is a possibility of symptoms progression, and you need to seek treatment.

Outlook

The prognosis of Dupuytren contracture is generally positive. Although there is no cure, the condition is slow to progress and highly treatable, with various treatment options available that help ease symptoms. Dupuytren contracture is also benign and is not associated with cancer symptoms or causes.