Dupuytren's Contracture (Hand Contractures)
Hand contractures are typically caused by Dupuytren's (du-pwe-TRANZ) contracture. This is a hand deformity that usually develops slowly, over years, affecting a layer of tissue under the skin of your palm. Knots of tissue form under the skin, which eventually form a thick cord that can pull one or more of your fingers into a bent position.
Symptoms of Dupuytren's contracture
Dupuytren's contracture can develop over weeks or months. In some people it progresses steadily, while in others it may start and stop.
This condition usually begins as a thickening of the skin on the palm of your hand. As Dupuytren's contracture progresses, you may notice the skin appears puckered or dimpled on the palm of your hand. A firm lump of tissue may also form on your palm. This lump usually is not painful, but may be sensitive to the touch.
As Dupuytren's contracture progresses to more advanced stages, cords of tissue form under the skin on your palm. This tissue may extend up to your fingers. As the cords tighten, your fingers may be pulled toward your palm. This may be mild or may be very severe, hindering daily activities.
The "ring finger" and "pinky" are most commonly affected by Dupuytren's contracture. However, the middle finger may also be involved. In rare cases, the thumb and index finger may be affected. Dupuytren's contracture can occur in both hands, however one hand is usually more severely affected than the other.
What Causes Dupuytren's contracture?
Doctors do not know what causes Dupuytren's contracture. Some researchers have speculated that it may be associated with an autoimmune reaction, where a person's immune system attacks its own body tissues. Dupuytren's often occurs in concert with conditions that cause contractures in other parts of the body, such as the feet or penis.
Risk Factors
There are a number of factors that are believed to increase your risk of the Dupuytren's contracture. These include:
Age - Those over 50 years of age are more likely to experience Dupuytren's contracture.
Gender - Men are more likely than women to develop Dupuytren's and may also have more severe contractures.
Ancestry - People of Northern European descent are at higher risk of the disease.
Family history - Dupuytren's contracture often runs in families.
Tobacco and alcohol - Smoking may increase the risk of Dupuytren's contracture. This could be due to microscopic changes within blood vessels caused by smoking. Alcohol intake also has also been associated with Dupuytren's.
Diabetes - Those with Diabetes are reported to experience an increased risk of Dupuytren's contracture.
Treatments
If Dupuytren's progresses slowly, does not cause pain, and has little impact on your ability to perform everyday tasks with your hands, you may choose to wait and see if Dupuytren's contracture progresses before seeking treatment. However, if the condition is progressing, causing pain, or interfering with the use of your hands, there are safe and effective treatments available.
Treatment for this condition can be done in several different ways. It involves removing or breaking apart the cords that are pulling your fingers in toward your palm. Your doctor will recommend a procedure based on the severity of your symptoms and a further analysis of your health. Some of the options include:
Needling
This technique uses a needle, which is inserted through the skin to puncture and "break" the cord of tissue that's contracting a finger. Contractures often recur, however this procedure can be repeated. The primary advantages of the needling technique are:
It does not require an incision
It can be done on several fingers at the same time
Very little physical therapy is required following this treatment
The main disadvantage is that there are some locations in the finger in which needling cannot be performed, because it could damage a nerve or tendon.
Enzyme injections
When a type of enzyme is injected into the taut cord in your palm, it can soften and weaken it. This allows your doctor to manipulate your hand in an attempt to break the cord and straighten your fingers. The advantages and disadvantages of an enzyme injection are similar to thos of needling.
Surgery
Another treatment option for Dupuytren's contracture is to surgically remove the tissue in the palm that has been affected by the disease.
The primary advantage to surgery is that it results in a more complete joint release than what is provided by the needle or enzyme methods. The main disadvantages include the necessity of physical therapy following surgery and, typically, a longer recovery time.
For more information or to schedule an appointment with Dr. Sagini, call 239-337-2003.
