It is not known for certain what causes Dupuytren’s Contracture. There are risk factors associated with it such as ancestry, heredity, alcohol intake, smoking, gender, age, and certain medical conditions. Also, more men than women get it.
Also known as“palmar fibromatosis”, this is a condition that causes the palmar fascia of the hand to abnormally contract and tighten up which in turn leads to involuntary curling of the fingers in toward the palm, or out to the side.
The palmar fascia is a flat sheet of connective tissue that connects all of the finger tendons together. For reasons not entirely understood, this fascia tissue can start to get tough and fibrous over time and become inflexible.
It most often affects the little finger and the ring finger, then lastly the middle finger. It is very rare for it to affect the index finger and thumb. It is common to get it in both hands (bi-laterally), with one hand usually worse than the other, although it seems to have no correlation to whether you are right or left-handed.
Mostly affecting people over the age of 50, it seems to be less common in women than in men. Women also tend to develop it later in life than men do, and with less severity. It is also possible for children to suffer from it, but is quite unusual.
In the USA, approximately 5% of people suffer from Dupuytren’s Contracture, but the condition affects up to 10 x more people of Northern European descent, especially from Scotland, Ireland, England, and Scandinavia. It is believed to have originated from the Vikings and is also known as “Celtic Hand” or “Vikings’ Disease”.
It isn't known exactly what causes Dupuytren's Contracture, but there are several possible associated risk factors. None of these are confirmed as the direct cause of the condition, but here we take a look at each of them:
During many studies into Dupuytren’s Contracture, there have been possible links made between high levels of alcohol consumption and chronic liver disease, but there is no conclusive evidence that either of these is the direct cause.
In a study of participants to analyze any possible links between alcoholism or regular consumption of alcohol, and/or liver disease with Dupuytren’s Contraction, it was found that alcohol seems to be a likely a key factor.
This is another possible cause of Dupuytren’s Contraction with studies indicating a likely link between smoking and the development of excessive myofibroblasts. These are thought to be what causes the abnormal contraction of the palmar fascia, by producing elevated levels of collagen. This in turn stimulates the growth of nodules and thereby alters the structure of the palmar fascia tissue.
Possible association with Diabetes Mellitus hasalso been observed. The changes in the small blood vessels seen with Dupuytren’s Contraction are very similar to those seen in diabetic patients, both type 1 and type 2.
Interestingly, the gender ratio is equal with diabetic patients suffering from Dupuytren’s Contracture when compared to non-diabetics, where men are more likely to suffer from this condition. It is also considered by some that Dupuytren’s Contraction could be a warning sign of diabetes, or possibly of late complication of existing diabetes.
It was observed back in the 1940s in Denmark that people who suffered from epilepsy had a tendency to develop Dupuytren’s Contracture. With 50% of males and 25% of females displaying symptoms, it became an area of much research.
However, it is still unclear whether epilepsy itself is a causative factor, or whether it is a possible side-effect of the anticonvulsant medication taken by people who suffer from epilepsy. The difference in the types of epilepsy is not thought to have relevance.
It has been thought that Dupuytren’s Contracture could occur as a result of a previous injury, or amongst those who have/had manual jobs involving lots of use of the hands. However, there has been no confirmation of this, but controversially this could be because of an increase in claims for compensation. This may then have resulted in noofficial link between the two.
Although there is supposedly no definite link between heavy, manual labor and Dupuytren’s Contraction, it is thought that those with a family history of this condition are more susceptible and can develop it following a hand-specific injury.
Dupuytren’s Contracture is a hereditary condition. It mostly occurs in white populations with very rare occurrences of it in Asian or African populations. Native Northern European and Scandinavian populations have the highest incidences, and its supposed Viking roots explain how it traveled around the globe.
The chances of developing this disorder below the age of 50 are far more likely if there is a family history of it.
All studies have shown that Dupuytren’s Contracture affects males more than females, with men beingup to 4 x more likely to get it than women. This ratio varies with different age groups, but the highest ratio was between the ages of 45-54 years of age.
It is not yet known why there is such a difference between genders despite several studies being conducted.
Out of all the different possible contributing factors, age is by far the highest, with incidence increasing post 55 years of age. This condition can get progressively worse with age, with more nodules appearing, or in the size of the existing nodules.
In the main, most patients do not experience pain from this condition. A small proportion of sufferers report extreme pain but it is not known why some experience this, yet others don’t.
It is reported by sufferers to be more of a nuisance than painful, due to the inability to use the hand properly and be able to perform certain tasks. It can also cause a thickening of the skin on the palm of the hand, adding further to the general inflexibility of the fingers.
If you do suffer from pain with this condition there are some topical creams that can be used. These have varying reports of efficacy with some people reporting good pain relief and slightly less tightness in the affected area, but others reported no improvement at all.
It should be understood that you will not be able to re-straighten your fingers without medical intervention once they start to curl.
There are a few procedures to choose from, depending on the severity of your condition. These should be considered if the condition is impacting your day-to-day life:
This is an injection of an enzyme that is extracted from a certain bacteria. The idea is that once injected into the affected area, the enzyme will then start to break down the toughened, tight tissue. This can be conducted at a doctor’s office and you will be required to return, usually within 1-4 days, to have the hand manipulated.
Do be aware that this injection is very expensive and will be excluded from a lot of medical insurance plans.
This treatment is slightly invasive with a needle being used to relieve the contracture by releasing the cords. It involves having the tip of the needle manipulate the problem area via small punctures to the skin. Using this method the contracted tissue can be severed, providing relief and better flexibility.
This is considered to be a very safe and inexpensive choice. It is a relatively easy-to-perform procedure with very low risk of any serious complication, although mild ones may be experienced.
This procedure usually takes less than an hour and most often no follow-up visit is required. The negative side of this procedure is that recurrence of the condition is common and occurs quicker than after surgery.
Surgery is usually the best form of relief for this condition but is not usually done unless the condition is bad enough to deem it necessary. This is because Dupuytren’s Contracture is a recurring condition, so you wouldn’t want to keep having operations.
Dupuytren's Surgery usually involves making an incision at the site of the contracture and taking away the abnormal tissue that is causing the problem. It is then stitched up to heal and you will be sent home wearing a bandage and splint.
Unfortunately, full recovery from this operation can take quite a long time, with the bandages in place for a few weeks and the splint quite often having to be worn for a few months.
This would then be followed up with physiotherapy to get everything moving again. However, this option does provide the longest period between recovery and recurrence, so hopefully, you wouldn’t need to go through it again.
Your surgeon would discuss the best options open for you, but if you do have to go the surgical route, you can at least rest assured that you will be having the most effective treatment, and the longer recovery period should be well worth the end result.
It is important that you keep in mind that there is no cure for this condition, but the procedures above will provide relief and give you back better use of your hands, therefore greatly improving the quality of your daily life.
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