Dupuytren’s contracture is a progressive hand condition that can limit how much you can move or straighten your fingers. The condition is caused by a buildup of collagen under the skin. Collagen thickens into a rope-like cord that extends from the palm to the finger. Over time the tightening cord can make fingers bend inward toward the palm, which is called contracture, making the fingers unable to straighten completely. This can complicate everyday activities such as placing your hands in your pockets, putting on gloves, or shaking hands.
What causes Dupuytren’s contracture?
It is unknown what causes Dupuytren’s contracture, but most evidence points towards genetics. According to the Academy of Orthopaedic Surgeons, people of northern European (English, Irish, Scottish, French, and Dutch) and Scandinavian (Swedish, Norwegian, and Finnish) ancestry are more likely to develop the condition, hence the colloquial term of “Viking disease”. There are a number of factors believed to contribute to the development or worsening of Dupuytren’s contracture.
- Gender: Men are more likely to develop Dupuytren’s and to have more severe contractures than are women.
- Family history: Dupuytren’s contracture often runs in families.
- Tobacco and alcohol use: Smoking is associated with an increased risk of Dupuytren’s contracture, perhaps because of microscopic changes within blood vessels caused by smoking. Alcohol intake also is associated with Dupuytren’s contracture.
- Diabetes: People with diabetes are reported to have an increased risk of Dupuytren’s contracture.
- Age: Dupuytren’s contracture occurs most commonly after the age of 50.
Symptoms of Dupuytren’s contracture
Dupuytren’s contracture progresses slowly over the years. Dupuytren’s contracture is typically first detected when a lump of tissue forms under the skin in the palm. As the disease progresses, the condition cause fingers to curl, which makes it difficult to grasp items and the skin on your palm might appear dimpled or pitted. The ring and small fingers are most commonly involved but Dupuytren’s contracture is not typically painful.
Signs and symptoms of the condition may include:
- Nodules: You may develop one or more small lumps
- Cords: The nodules may thicken and contract, affecting the formation of dense and tough cords of tissue under the skin
- Contractures: When the tissue tightens, one or more of your fingers may be pulled which restricts them from spreading apart
Treatment for Dupuytren’s contracture
Currently, there is no cure for Dupuytren’s contracture. The treatment of Dupuytren’s contracture depends on various factors such as the stage and severity of the cord, the patient’s age and general health, the patient’s occupation, the status of the skin of the palm, or the presence of bony deformity. In fact, the condition may never progress past developing lumps in the palm.
If the condition does progress, Raleigh Orthopaedic hand & wrist specialists may recommend nonsurgical treatment, such as steroid injection or bracing/splinting, to help slow the disease down.
Recently, XIAFLEX® injection was approved by the US Food and Drug Administration (FDA) as the first nonsurgical option for the treatment of adult patients with Dupuytren’s contracture for the treatment of adults with Dupuytren’s contracture. When injected into the cords of tissue, the injection works to disrupt collagen that forms the cord causing the affected finger to permanently bend or contract toward the palm of the hand. The patient returns within one week to have the finger stretched back out to a straightened position. Oftentimes, patients will feel the cord pop or snap before they actually come back for a stretching, such as when lifting a bag of groceries.
Fasciectomy is a procedure in which diseased tissue is removed through incisions in the palm and affected finger(s). Surgery would help reduce the contracture with a goal to improve finger motion and function.
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