Dupuytren’s contracture is acondition that affects the hands. In time, it causes the ring and little finger to stay in a bent position and it is sometimes associated with pain.
It is a progressive disease that takes years to develop and that compromises the full range of motion that a person can make with their hands.
Pain is a very subjective feeling and the level of pain felt by different individuals, in the same circumstances, can be very diverse. Some people may perceive stimuli to be very painful while others may not feel pain at all.
Dupuytren’s contracture is a disorder that gradually affects the hand by thickening the skin and forming thick strings on the palm.
These strings pull on the fingers, usually the ring and the little finger, destabilizing the hand, and bringing the fingers towards the palm.
This happened because of excessive collagen buildup and tends to appear after the age of 40.
Patients with Dupuytren’s contracture have difficulties grasping some objects, and those who use musical instruments like guitars or pianos might need to readapt to their new hand configuration.
As with any other type of pain, the one caused by Dupuytren’s contracture can be perceived as very painful or not painful at all.
Most patients don’t find it painful, and this has created an entirely different issue.
As most health professionals agree to the notion that Dupuytren’s contracture isn’t painful, those who are in pain are somewhat marginalized as they are being told that it isn’t supposed to hurt.
In turn, their anxiety level spikes as they can’t find many people who understand what they are going through.
Dupuytren’s contracture can cause both pain and itching of the skin and nodules. There seems to be adirect relationship between the time the signs of the disease first appeared and the level of pain.
As such, patients who first noticed symptoms before turning 40, were more likely to experience pain and itching.
Dupuytren’s contracture is a fibrotic disease. This means that the body will produce a high number of fibrocytes. These are white blood cells that are produced inside our bones, by the bone marrow.
The fibrocyte’s job is to attack the cells that produce distress, in this case the skin that becomes tightened in Dupuytren’s contracture. When they reach that portion of the skin, they become myofibroblasts, tightening the skin even harder.
However, this process doesn’t happen in all patients. This type of immune response can be painful, and this is why only some patients report itching and pain.
Furthermore, Dupuytren’s contracture can aggravate the symptoms of other diseases affecting the hands, like arthritis, rheumatoid arthritis, tendinitis, or even old injuries.
This type of pain is indirect, and even if patients associate it with the tightening of the skin in their palms, the source of the pain itself is different.
All in all, statistically speaking, pain associated with Dupuytren’s contracture alone is rare.
Dupuytren’s contracture cause is idiopathic. This means that we don’t know all the reasons for which it appears, and we can only look at statistics and at certain risk factors.
The condition has been linked to:
Those who have a parent with Dupuytren’s contracture will not necessarily develop the condition. However, in some patients who had a predisposition, the disease was triggered by hand surgery or a hand injury.
What are the symptoms of Dupuytren’s contracture?
The disease tends to progress slowly, even if there are a few rare cases of aggressive forms that move fast.
The first symptom is usually a small nodule on the palm that sends the patient to the doctor for fear of cancer.
The nodule is begin and becomes the first clue of what is to come. It isn’t painful, unless moderately strong pressure or strain is put on the area surrounding it.
Later on, the disease progresses with more nodules and cords that pull on the fingers that impair the function of the hand affected and occasionally become painful.
The severe form, that has an early onset, affecting younger patients, may be more painful, and can affect both hands. In extremely rare cases, it may even affect more fingers.
Treatment for Dupuytren’s contracture varies depending on the progress of the disease, the general health of the patient and how affected the hands are.
In the early stages, the hand specialist that the patient is referred to usually recommends monitoring and nothing more. This happens because the condition may or may not progress, as there are cases when it stagnates in incipient stages.
However, any nodule, no matter where it is on the body, should always be checked by a specialist. You should never think that maybe it will go away.
The doctor will first diagnose the patient but sadly, there isn’t a specific blood test or imaging test that can be conducted in order to make an accurate assessment.
This is why it is important to be evaluated by a specialist, rather than a general practitioner.
The medical professional will assess the patient and will evaluate hand function. After that they are likely to recommend a reassessment every three or six months, according to the stage of the disease.
Furthermore the treatment divides into surgical and nonsurgical.
Surgery is only recommended when and if the condition has progressed to a level at which the patient’s hand movement is greatly flawed and his day-to-day activities have become impaired by this.
The surgery isn’t a high risk one but it does require a highly experienced surgeon.
During the operation, the specialist will remove excess tissue from the palm of the patient, restoring the range of motion of the fingers.
Some surgeons choose to operate under general anesthesia, while others prefer only local anesthesia.
Aftercare is important too, and the medic might recommend kinetotherapy or additional treatment.
Unfortunately, there is no way of knowing if the condition will be completely eliminated or if it will return.
The nonsurgical approach is aimed at maintaining as much range of motion of the fingers as possible, at slowing the progression of the disease and at minimizing symptoms as pain and itchiness.
There are a few nonsurgical options that can be used by patients with Dupuytren’s contracture. These are:
This treatment dates back to 1947 and uses doses of up to 300mg natural vitamin E. It is a bit controversial, as patients noticed mild improvements especially pain wise, but the measurements showed that it was inefficient.
However, there are little side effects and it is considered a safe option.
Physicians may recommend a stretching routine for the hands of patients with this condition. It was shown that along with other treatment options it can help to maintain mobility.
This is a treatment aimed at relaxing and loosening the tissue that causes the contracture. The injections are usually followed by a stretching routine and require repetition.
Cortisone injections are especially useful in the early stages of the disease, actively shrinking nodules and slowing the progression of the condition.
However, they do need repetition which can be uncomfortable.
There are a few alternatives that may help to improve the pain and itchiness associated with Dupuytren’s contracture.
Arnica Montana wasshown to reduce pain and inflammation for patients who had surgery of the hand.
Furthermore, Aloe Vera hassignificant anti-inflammatory effects but it can also protect the skin and ease itchiness.
A combination of these natural treatments can be found increams that are especially beneficial if used along other treatment methods like stretching and enzyme or cortisone injections.
What most people don’t realize about Dupuytren’s contracture is the fact that it doesn’t only affect a person’s hands.
It also affects the mind, raising the level of anxiety because they can no longer rely on their hands the way they used to.
Furthermore, painful Dupuytren’s contracture can cause the patient to feel depressed and misunderstood by family, friends and even medical staff because everyone is under the impression that this condition doesn’t hurt.
One of the most important steps to take when addressing Dupuytren’s contracture is to find support and to engage with people who are in the same situation as you are.
There are many resources bothonline and offline that can help patients and using them should become a priority.
Having a support group in your area can help you obtain access to useful information and to learn about new and efficient treatments.
Living with Dupuytren’s contracture is not easy, but the good news is that there are many treatment options, and that the condition progresses slowly.
This means that if you address it early and you act fast, you might never have to learn how much it can impair the function of your hands.
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