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Dupuytren’s Contracture: What it is and how to treat it?
What is it?
Dupuytren’s Contracture is a little known yet increasingly common condition affecting up to 17 per cent of the Australian population over the age of 50. It is a progressive condition in which the tissue between your palm and fingers begins to thicken, forming a cord. Over time, this cord can cause your fingers to bend towards your palm, hindering you from being able to fully extend your fingers and obstructing your ability to perform normal everyday activities.
Traditional folklore states that Dupuytren’s Contracture originated with the Vikings, who spread it throughout Northern Europe and beyond as they traveled and intermarried. Many years later, it was named after a famous French surgeon who studied the condition.
The condition usually targets the ring and little finger, but any finger can be affected. It can begin in spasmodic fits and take many years to interrupt normal hand functioning. While there is not usually any pain associated with the condition, other visible signs and symptoms can include:
- A lump or nodule on the palm, usually close to the base of the ring or little finger.
- The appearance of a thickened cord running along the palm to the fingers.
- The hand bows.
- Fingers can be completely pulled against the palm in a claw-like fashion.
- Skin of the palm may be dimpled and puckered.
Are you at risk?
The exact cause of Dupuytren’s disease is unknown, however there are several factors which may place you at higher risk. These include:
- Age – men between the ages of 50 – 60 years old most commonly develop the condition.
- Gender – males are three times as likely to develop the disease and are more likely to experience severity of the condition.
- Ancestry –people with Celtic or Scandinavian ancestry are at increased risk (blame those Vikings)!
- Certain medical conditions – people with diabetes and epilepsy have a higher incidence of the condition, while those with rheumatoid arthritis have a lower incidence.
- Alcoholism – the contracture tends to be common, and comparatively more severe, in alcoholics.
Other potential factors that may increase your chances of developing the disease include: manual labour with vibration exposure, prior hand trauma, smoking, and complex regional pain syndrome (CRPS).
How can you treat it?
Treatment involves removing or breaking apart the cords that are pulling your fingers in toward your palm. This can be done in several different ways. The choice of procedure depends the severity of the condition, individual health and circumstances. Treatment options include:
This technique uses a needle, inserted through your skin, to puncture and separate the cord of tissue that's contracting a finger. The main advantages of this technique are the fact there is no incision, it can be done on several fingers at the same time, and usually very little physical therapy is needed afterward. However this technique can’t be used in some locations in the finger, as it could damage a nerve or tendon.
Injecting an enzyme into the cord in your palm can soften and weaken it — allowing your doctor to later manipulate your hand in an attempt to break the cord and straighten your fingers. The results of this procedure are similar to needling, however the injection may initially be more painful.
In severe cases, a person is unable to lay their hand palm-down on a flat surface, or their fingers have contracted into their palm so that the hand is no longer functional. At this point, surgery often becomes the only viable option and in extreme cases, a skin graft can be required.
The main advantage to surgery is that it results in a more complete joint release than offered by alternative methods, however physical therapy is usually required after surgery, and the recovery time can be longer. Occupational and physical therapy following surgery involves; wearing a splint to straighten the finger, hand exercises to encourage flexibility and massage techniques.
It is possible for Dupuytren's Contracture to return after surgery, either at the same site or elsewhere on the palm. Usually, the contracture progresses at the same speed as previously.
When surgery is the only option
Your surgeon will discuss surgical options with you and work to find the most appropriate procedure. Usually performed under general anesthetic, surgery is a one day procedure, although more complex procedures can require an overnight stay.
It is important that Dupuytren’s Contracture and other hand deformities are treated by skilled surgeons specialising in these conditions to ensure the best chance of a good result.
The Melbourne Institute of Plastic Surgery offers excellent results for the treatment of Dupuytren’s Contracture, through its close association with the Malvern Hand Therapy group.
To learn more about Dupuytren’s Contracture, visit the Melbourne Institute of Plastic Surgery, complete a contact form or call us on (+61 3) 9508 9508.