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Dupuytren's Contracture: Symptoms, Diagnosis and Treatment

October 14, 2020

Do your fingers curl inward, and you have difficulty or feel pain whenever you try to straighten them? Do you feel a knot in your palm that is sensitive when touched? These are some symptoms of a condition called Dupuytren's Contracture. While it is not life-threatening, it can limit your ability to use your hands. In this article, we’ll help you understand the disease, early symptoms and progression, and the treatment and relief you can get.

What is Dupuytren's Contracture?

Dupuytren's (pronounced as “du-pwe-TRANZ”) disease affects the connective tissue under the palm called the fascia. The fascia has strands of fibres that look like loose cords running from your palm down to your fingers.

The disease causes the fascia fibres to thicken and contract. As it progresses, these become knotted and create a thick cord that can pull your fingers inwards. Here are the stages, and the symptoms you may experience:

Stage 1: Nodules

You may notice a small and painless lump (called nodules) in the area near your ring finger and small finger. Many people mistake it for a callous or a patch of rough skin. Sometimes it can feel sensitive and tender, itchy,  or have mild burning sensation. “Patients describe the tenderness as similar to a bruise that is resolving or a cut that is in the last stages of healing." says Dr Charles Eaton, the founder of the Dupeytren Foundation. (Source:WebMD)

Stage 2: Cords

The nodules become thicker, and the skin around it begins to shrink. You may first notice that your palm looks dimpled or puckered. This area may feel more sensitive when you push into it, but it’s very rare to feel pain.

Stage 3: Contraction 

Most people start to notice the disease when the fascia shrinks to the point that it contracts the fingers. Your finger may feel tight and difficult to flex. In its later stages, it will be impossible to completely straighten the affected fingers. 

Will Dupuytren’s Contracture affect my whole hand?

The disease usually affects the pinky and ring finger (or the two fingers farthest away from the thumb). However, you may still use your pointer finger or thumb, which will let you still retain some use of your hand.

Dupuytren’s Contracture initially manifests in just one hand, but about 80% of people eventually develop it in both hands (Source:Medline). Usually, the condition is more severe in one of the hands.  

The disease usually develops over several years. it’s important to seek treatment early to relieve pain and discomfort, and slow down its progression.

Dupuytren’s Contracture does not spread to the rest of the body. However, those with the disease have a higher risk for other connective tissue abnormalities, such as Garrod Pads (nodules on the knuckles) or Ledderhose Disease (which affects the feet).

What causes Dupuytren’s Contracture?

The fascia can become thicker because of an excess of myofibril protein strands, also called myofibrils.

Myofirbrils are the basic component of muscle fibres. People who have Dupuytren’s Contrature have overactive myofibrils, which cause the tissue to thicken and produce more Type III Collagen. Scientists believe the condition is linked to some genes that affectWnt Signaling Pathway, but further research is needed on how it triggers the disease. However, they have identified some risk factors:

  • Genes and ancestry.Approximately 7 of every 10 people who have Dupuytren’s Disorder have a family history of the disease (source:News Medical). It also tends to appear more frequently in people of North European descent.  
  • Gender.The disease is more likely to develop in men.
  • Age.Symptoms tend to appear after the age of 50.
  • Smoking and alcohol use
  • Diabetes
  • Epilepsy

How is Dupuytren’s Contracture diagnosed?

If you see any signs, go to a doctor. He will examine your hands, wrists and fingers for signs of tenderness, dimpling, and skin pitting. He may ask you to perform simple tasks to check your hand’s flexibility and range of motion. This can include:

  • Placing your hands on a table
  • Holding objects
  • Stretching your fingers
  • Feeling objects with your thumbs and fingers

During the physical examination, your doctor will be able to find the site of the nodule and the presence or severity of contractures. He may take pictures of the hands for documentation. You will need to return regularly to monitor the disease and determine if your condition is becoming worse.  

What treatments are available?

In the early stages, your doctor will manage your condition with observation and non-surgical therapy. He may prescribe creams or other medicines to provide relief. To prevent surgery, your doctor may use steroid injections in the clinic to slow down the disease’s progression. (Source:AAFP).

There is no cure for the disease, but when it reaches the severe stages, your doctor may recommend surgery to help you regain some use of your fingers. The surgery entails dividing or removing the thickened bands. Recovery time is about two to three months, and possible complications include nerve injury and permanent stiffness. Bear in mind that the diseasecanreoccur even after surgery—so it is not a cure, but a way of buying time.

How will the disease affect my everyday life?

At the beginning of the disease, you will only experience small and inconvenient changes. You may not be able to bend your ring finger, or you will have trouble with specific activities like shaking someone’s hand,  getting your hand out of your pocket, or wearing gloves.

As the disease progresses, and your fingers curl inwards, you will experience difficulty in any task that requires you to flatten your palm. For example, it can be harder to shampoo your hair or wash your face. However, physical therapy can strengthen your fingers, and creams and injections may slow down this progression.

When fingers have already curled in, hygiene can become an issue. It will be difficult to clean the skin, so you are at a higher risk for fungal infections. You will need to pay closer attention to keeping your cleans, and thoroughly washing the area.

While there is no cure for Dupuytren’s Contracture, with the doctors’ help, you can manage the disease and its progression. However, you will also need to adapt and learn how to do everyday tasks differently. You can still continue to enjoy hobbies and quality of life.

 


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