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How Serious Is Dupuytren's Contracture?

January 12, 2021

Dupuytren's contracture is a condition in which one or more fingers start to bend in towards the palm. Essentially, it is a deformity of the hand occurring due to thickened tissue under the skin of your palm or fingers.

Overview of Dupuytrens Contracture

Depuytren's contracture initially starts as a simple lump, dimple, or ridge forming in the palm. With time, the condition can develop and worsen over months and years. The skin tissue in the base of the palm first gets affected. This causes knots of tissues to form under the skin.

Eventually, the knots can turn into a thick cord that will pull the fingers into a bending position.

Causes ; Risk Factors

The exact cause for this hand deformity is still not known in the medical field. No evidence has been found to link the condition with a hand injury, or any sources of vibration that could cause it. 

However, doctors have found a number of factors that put certain people at risk for Dupuytren's contracture.

The factors that may increase your risk for the disease include:

Age:The condition more commonly affects people over the age of 50.

Sex:Men are at higher risk for Dupuytren's contracture, and it also affects them more severely.

Genetics: The disease often runs in families. You are at higher risk if a family member also has the condition.

Diabetes: People suffering from diabetes are also more likely to develop Dupuytren's contracture.

Seizure Medicines: There is a link between medicines taken for epileptic seizures and a higher risk of Dupuyten's.

Tobacco ; Alcohol:Smoking ; consuming alcohol are associated with an increased risk for Dupuytren's which may be due to changes in the blood vessels caused by their intake.

 

How serious is Dupuytren's Contracture?

The initial stages of the condition are not serious as there is a simple lump or nodule formation. With time, this lump gets hard and over a period of months or years, the condition gets more severe. 

As the condition progresses, the skin of your hands may start to appear dimpled. The firm lump on the palm can also be sensitive to touch, but usually does not cause pain.

During the later stages of Dupuytren's contracture, there are chances of severe effects. The knotted tissue cords under the skin start to extend to the fingers. One or more affected fingers will involuntarily start to curl or pull towards the palm.

At this point, patients begin to face difficulty in performing a number of daily functions. It will also be hard to lay down the hand in a flat position. 

With increasing severity, it may become impossible to use the hands to perform certain tasks. At this point, the fingers may get permanently stuck in the bent position. 

The condition further disrupts daily functions when it occurs in both hands. In most cases, one hand is usually more affected. It is more common for the farthest two fingers from the thumb to get affected. Sometimes, the middle finger is also impacted.

It is extremely rare for the index finger and thumb to get affected by Dupuytren's contracture. This means for a majority of people it won't cause major inconvenience while performing motor activities like writing. By the time the condition gets very severe, there will be issues in opening the hand fully, grasping objects, or bending hands for more delicate tasks.  

Is Dupuytren's Contracture Painful?

The pain associated with Dupuytren's contracture can vary from patient to patient. According to a majority of Dupuytren's patients, it does not cause them pain. Hence, the painfulness of the condition is seldom discussed. 

However, a number of people suffering from the condition have reported that it hurts. The reason for pain occurring in some patients and not others is unknown.

In fact, this hand deformity can be extremely painful for some patients. The disease can often co-exist with other painful hand diseases like arthritis, which may also be causing  pain in patients.

According to the Dupuytren's Research Group, itching and pain are quite common in patients with Dupuytren's contracture and are reported by many of them. It has been found that pain and itching are more common in patients with earlier onset of the disease. This indicates aggressive worsening of the disease in such patients.

Symptoms of Dupuytren's Contracture

  • Thickening of the skin
  • Dimpled or puckered appearance in the palm 
  • A lump or nodule forming in the skin underneath the palm
  • Hardening of this lump, making it more sensitive to touch
  • Being unable to put the hand down in a flat position
  • Farthest two fingers from the thumb curling inwards

Diagnoses

It is quite easy to diagnose Dupuytren's contracture as no surgical tests are performed. The doctor will examine the hand in a number of ways and come to a conclusion. 

They will check the flexibility of the hand and test the appearance and movement of the thumb and fingers. The doctor also will also test you by checking your pinching and gripping strength.

Furthermore, the doctor measures and notes down where the nodules are located. They may also use a special tool to measure the length of bending in the fingers to check how much they have contracted. The fingers' range of motion is also recorded.

By undergoing this analysis, your doctor will tell you if you have Dupuytren's contracture. They will also compare these measurements with later measurements over time to notice progression or check if treatments are working.

Treatments ; Relief 

Dupuytren's contracture cannot be cured. As the condition is not dangerous, many patients leave it untreated. However, you can find a treatment to help slow down its progression and ease some of the uncomfortable symptoms.

Once you opt for treatment, your doctor or practitioner will devise a healthcare plan for you specifically based on:

  • Your age,
  • Your overall health condition, and health history and underlying conditions
  • The severity or progression of your case 
  • Your reaction to certain medicines, therapies, or treatments
  • How much your condition is expected to worsen
  • Your personal decision 

Non-surgical treatment

Stretching: For all cases, and mostly the mild ones, a stretching program is devised by the doctor. It is often used in combination with other treatments.

Steroid Shots/Injections: These are inflammatory medicines that are injected into the lumps or nodules forming in the hand. Mostly, multiple injections have to be given. These will help to reduce the size of lumps early on. However, injections become less effective when the disease has already progressed. In case the fingers have already contracted, the steroid injection cannot help in straightening them.

Radiation therapy: This type of treatment uses low-energy X-ray radiations that are directed towards the lump formations. It is also recommended in the earlier stages of the condition as they work by softening the thickening skin tissue, ultimately preventing the contractions in the fingers.

Enzyme Injection: A more recent treatment option, this is a less invasive procedure that an expert surgeon can perform. A medicine is injected in the affected area which numbs the whole hand. Then, the enzyme is injected into the nodule or lump. The enzyme then breaks down over a few hours, dissolving into the skin tissue. The next day, the surgeon will snap the cord, and the result is straightened fingers.

Needle aponeurotomy: Another new treatment method which is non-invasive. The hand is first numbed by using the medicine. Then, using a needle, the surgeon divides the affected tissue without making any incision. 

Open Surgery: This is performed by a surgeon who will make an incision to divide (fasciotomy) or remove (fasciectomy) the thickened tissue bands, fully or partially. The wound can be closed using a number of techniques. For the incision to heal, a skin graft may be required at times.

Dupuytren's Contraction All-Natural Cream: For patients who want to avoid injections, needles, or surgery, another option is using an external, anti-inflammatory relief cream.

Manufactured and sold by Dupuytrensco, the cream is the most natural and non-invasive treatment option as it uses an 'all-natural' approach to help treatment. The active ingredients are arnica-montana, tamasul oil, aloe-vera, sunflower oil, and vitamin E that work in preventing progression by softening the lumps.

The cream is recommended twice a day to patients and must be vigorously rubbed into affected areas like the palm and fingers. Noticeable results are generally seen after 30-45 days of use. There are no known side-effects of this treatment option and many patients have observed improvement in their condition. It is a safe solution and is readily available (you can buy ithere)

Potential Complications of Treatments

Open-surgery and needle aponeurotomy do pose a risk for complications. It may be possible to have a recurrence of finger contractures despite having these surgeries. Furthermore, there can be reactions to the wound when such a procedure is done.

When should you call your healthcare provider?

If you feel your symptoms have progressed drastically, or if your Dupuytren's contracture is giving you severe discomfort, you should immediately call or visit your doctor and get it checked.


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