Dupuytren's contracture (Morbus Dupuytren)
Dupuytren's contracture is a slow-progressing hand deformity that typically develops over several years. It affects a tissue layer under the skin of the palm. Knots of tissue form a thick cord that can pull one or more of the fingers into a bent position. Although painless, the condition complicates everyday life because the affected fingers cannot be fully straightened anymore. There is no cure for the disease. The goals of the treatment are to slow the progression of Dupuytrens or to improve hand function.
The following signs normally occur gradually:
- Thickening of the skin on the palm of the hand
- Firm lump of tissue on the palm (may be sensitive to touch but not painful)
- Bands of tissue under the skin
- Cords tighten, and one or more fingers are pulled toward the palm
- Ring and little finger are mostly affected
- Difficulties to straighten finger
- Difficulties to grasp large objects and to put hand in the pocket
- May occur in both hands
Although the precise causes are unknown, some people may be at greater risk for getting Dupuytren's disease than others.
Risk factors include:
- Inheritance of the disease
- Drinking alcohol
- Medical conditions, e.g. diabetes, seizures
- Older age
Dupuytren's disease may limit the ability to fully open the hand, grasp large objects or put the hand into narrow places.
Dupuytrens cannot be cured. The goals of the treatment are to slow the progression of the disease or to improve hand function. As long as the condition doesn’t cause pain and the affected person can use the hands for everyday tasks, he/she might not need treatment. Instead, the patient can wait and check with the doctor if Dupuytrens develops over time.
Patients with mild symptoms may improve the condition by:
- Warming fingers up, e.g. with a heat pack
- Massaging the fingers with lanolin cream
- Stretching the fingers (e.g. bending them backward from the palm)
- Protecting the fingers (e.g. gloves with padding in order to grasp heavy objects)
If the condition is more severe, treatment involves removing or breaking apart the cords that are pulling the fingers toward the palm. Treatment options depend on the severity of the disease and other health problems of the patients.
A needle is inserted through the skin in order to puncture and break the cord of tissue that's contracting a finger. If the contractures recur, needling can be repeated. Advantage of the procedure: There is no incision, and it can be done on several fingers at the same time. Afterwards, only little physical therapy is usually needed. Disadvantage: The physician cannot puncture in all locations in the finger, because in some places, he could damage a nerve or tendon.
Compared to needling, enzyme injections might be more painful in the beginning. Apart from that, the advantages and disadvantages are similar. The goal of an enzyme injection is to soften and weaken the taut cord in the palm. That allows the doctor to manipulate the hand and to break the cord and straighten the fingers, if possible.
Another option is operation: The surgeon removes the affected tissue in the palm. Sometimes it’s difficult to identify tissue in very early stages of Dupuytrens. If the affected tissue is attached to the skin, it might not be easy to remove. Advantage of surgery: The joint release is more complete in comparison with needling and enzyme injections. Disadvantages: Physical therapy is normally required after surgery, and the recovery time may be longer.
If the patient suffers from severe Dupuytren's contracture, the surgeon may perform a very invasive operation by removing all the tissue likely to be affected by the disease, including the attached skin. Afterwards, a skin graft is required to cover the open wound. In general, the patients need months of intensive physical therapy after the procedure.
The disease cannot be prevented. If symptoms occur, a doctor’s visit is needed.