Causes and Treatment of Dupuytren's Contracture

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Dupuytren's contracture is a condition that causes tightening of the palmar fascia—the thick connective tissue that lies above the tendons and below the skin of your palm.

The palmar fascia helps provide a tough, gripping surface for the hand and fingers. However, with Dupuytren's contracture, the fingers can become permanently bent down, impairing the function of your hand.

This article discusses what causes Dupuytren's contracture, how the condition progresses, and the treatment options that are currently available.

Dupuytren's Contracture

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Causes

It's not yet clear what causes Dupuytren's contracture. It doesn't always run in families, but it tends to. Furthermore, people who have a family history of the condition tend to develop it earlier and more severely than those who don't have a family history of it.

Other factors have been linked to Dupuytren's contracture, including hand trauma, cigarette smoking, diabetes, epilepsy, alcohol use disorder, nutritional deficiencies, and certain epilepsy medications. However, more research is needed before any clear link is certain.

The condition is most common in men ages 40 and older with North European ancestry. One group commonly cited is those with Viking ancestry. In fact, the condition is sometimes referred to as Viking's disease.

There is evidence that hand or wrist injuries may trigger or contribute to the development of Dupuytren's contracture. Acute hand or wrist injuries can trigger the condition within one year of the injury. A history of manual labor may contribute to the problem as well.

Dupuytren's is often seen in both hands. It is found just as often in dominant and non-dominant hands, evidence that this problem is not entirely the result of acute or chronic hand trauma.

Dupuytren's Contracture vs. Disease

Most people, healthcare providers included, use these terms interchangeably. However, technically speaking, Dupuytren's disease refers to the increase in the number of cells in the affected hand tissues that causes the nodules and contractures to form.

Dupuytren's contracture is the result of this cell proliferation. It is the physical manifestation of Dupuytren's disease.

What to Expect

The first clinical signs of Dupuytren's contracture are usually small, painless nodules (abnormal growths) in the palm. The nodules may begin to join together and the skin becomes puckered.

Eventually, in the later stages of the disease, the skin and underlying fascia contracts, impairing hand and finger function. People with Dupuytren's contracture have fingers that are bent down towards their palm.

Dupuytren's contracture most commonly affects the ring and little fingers, although it can affect all fingers. Dupuytren's tends to progress in rapid bursts followed by periods of little change.

The condition is seldom painful but it can be a great nuisance. Although it usually limits what a person can do with their hand, a person can develop contracture in other parts of the body, most commonly the soles of the feet.

Dupuytren's contracture in the feet is known as Ledderhose disease. One study found that, out of 730 men with Dupuytren's contracture, 16% had Ledderhose disease.

Prognostic Factors

Dupuytren's contracture is a progressive condition, meaning that it slowly worsens over time. The condition progresses more quickly in some people than in others.

There are several risk factors that tend to influence how quickly a person's Dupuytren's contracture will develop and/or progress. Those factors include:

Heredity A history of this condition within your family is an indication that it will be more aggressive.
Sex Dupuytren's usually begins later and progresses more slowly in women.
Alcohol use disorder, epilepsy These conditions are associated with Dupuytren's that is more aggressive and more likely to recur.
Location of disease When in both hands, or when the feet are also affected, the condition tends to progress more rapidly.
Behavior of disease More aggressive Dupuytren's is more likely to recur after surgery and continue to be aggressive.

The more severe a person's Dupuytren's contracture becomes, the less likely they are to ever have normal hand function again.

Treatment

Many people with early-stage Dupuytren's contracture opt to forgo treatment while their condition is still mild.

Because surgical treatment is invasive and may require a longer recovery and rehabilitation, it was often reserved as a last resort option if symptoms started to interfere too much with daily activities.

Less-invasive treatments are also available. These options provide hope that Dupuytren's contracture can be well managed without surgery—especially if they are used in the early stages.

Observation

This is usually the best option for people who are not impaired by their hand function. This may include people with minimal contracture, or people who do not rely as much on their hands and can perform all their usual activities.

With this, you see your healthcare provider as recommended and the examine you, comparing what they find to previous visits to see if there have been any changes in your condition (and how fast they occurred).

Less-Invasive Procedures

These options are less invasive than surgery and may be effective for some patients.

Collagenase Injections

Collagenase is an enzyme produced by a bacteria that is injected into a Dupuytren's cord. The enzyme works by dissolving the tight Dupuytren's tissue.

One day after the injection, and after the enzyme has done its work, you return to a healthcare provider to have the finger manipulated. The manipulation breaks up the tightened tissue to restore finger mobility.

Needle Aponeurotomy

Needle aponeurotomy is a procedure developed in France that has only recently become more popular in the United States. It is most successful in the earlier stages of Dupuytren's contracture.

Using no incisions, a needle is used to separate the Dupuytren's cords and restore some or all of finger motion.

Rehabilitation after needle aponeurotomy is relatively quick. Patients can usually resume normal activities immediately and are instructed to refrain from sports and heavy labor for about a week.

Depending on the severity of contracture, a removable splint may be given. The splint may be worn only overnight or for a few hours each day.

This is a newer treatment to many healthcare providers, who therefore may not be inclined—or prepared—to use it. Some providers also view the treatment as controversial and will not recommend it.

If you want to discuss needle aponeurotomy with a healthcare provider, you can find a list of providers performing this procedure on the National Dupuytren Society website.

Surgery

In some patients with more severe forms of Dupuytren's, less-invasive treatments may not be appropriate or successful. In these cases, a fasciectomy will likely be recommended.

This surgery involves removing segments of the palmar fascia from the palm of the hand.

A fasciectomy can be effective at restoring function, but it usually has a longer rehabilitation period than the other treatment options.

Patients with minimal contractures may be able to resume normal activities once the incisions heal—usually within a few weeks. More severe contractures may require months of splinting and rehabilitation with a hand therapist to prevent scar tissue formation.

This is the most common risk associated with the surgery. It can lead to a problem similar to Dupuytren's contracture. Other potential issues with surgery include nerve injury, infection, and prolonged healing.

Unfortunately, Dupuytren's can return after surgery. Doing surgery a second time comes with major risks, including the risk that one or more fingers will need to be amputated.

Summary

Dupuytren's contracture is a progressive condition that causes connective tissues in the palms, known as palmar fascia, to tighten. As Dupuytren's worsens, the fingers bend toward the palm.

This can become permanent if the condition progresses too far. Treatments are most effective in the early stages of its development.

Less-invasive treatments can help maintain hand function in early stages, but more severe forms may require surgery.

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11 Sources
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