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Dupuytren's Contracture also called palmar fibromatosis is an atypical hardening, thickening and contraction of the tissue of the palm. The tissue hardens in a string-like shape in the area that connects the fingers to the center of the palm.
Therefore, it results in pulling the finger towards the palm, and not allowing them to fully stretch.
It was named by the surgeon Guillaume Dupuytren, in the 19th century, but it is said to be very old, to have been spread by the Vikings andit is hypothesized that those who carry Breton and Norman genes can also carry Dupuytren's Contracture disease.
Dupuytren's Contracture progresses in time and can become a disability because people who suffer from this condition will lose the ability to fully stretch their palm, to grasp large objects or to participate in activities that involve the movement of all the fingers.
It mostly affects the ring, and small finger but in some extreme cases it can alter the function of all the digits, including the thumb.
Dupuytren's Contracture is a form of disability, so in certain, but not all situations, you can obtain disability benefit for it.
To qualify for disability benefit you must meet some requirements. To begin with, you must not work and be paid more than $1260 (in 2020).
Another important factor is the fact that Dupuytren's Contracture affects your strength, so you will not obtain a benefit if you are working in an office where you don’t require strength.
However, you might obtain disability benefits based on the fact that Dupuytren's Contracture might qualify for a non-exertional impairment, meaning that it alters a person’s ability to do certain activities like ones that involve manipulating objects, climbing or handling produce.
The causes behind Dupuytren's Contracture remain largely unknown.
However, there are risk factors that have been associated with this condition and that should be considered when assessing the risk of developing the disease.
Dupuytren's Contracture usually begins with a small lump in the palm of the patient’s hand.
The lump is not malignant but signals the fact that the body has a disorder that produces collagen in unusual places. This nodule can sometimes be painful, if it’s pressed or stretched.
Thankfully, everything could stop there as sometimes the condition never progresses beyond that point.
If the condition advances, it usually does so slowly, over the extent of a few years.
More nodules appear on the palm, and eventually chords are formed. These cords pull on the fingers and restrict mobility.
Dupuytren's Contracture is not a painful condition for most patients, but for some it can be very painful and present with a lot of discomfort as the thickened skin also itches and stings.
In order to obtain a Dupuytren's Contracture you need to be seen by a hand pathology specialist. They are fully trained and experienced to correctly diagnose Dupuytren's Contracture.
In order to do this they will first assess the nodules in the patient’s palm. Then, they will look at the contracture of the tissue and the mobility of the fingers. They will record their findings, the level of the contracture and the place and extent of it.
There are three grades of Dupuytren's Contracture.
There are no specific tests that can be conducted in order to determine the diagnosis and it is purely observational.
The specialist will then advise you to get treatment or will recommend a “wait and see approach”.
If the disease is in the early stages, the consensus is to just wait and monitor the progress, as the condition may never progress.
If this is the case for you, you will probably be asked to return for monitoring in three to six months.
Any lump or nodule anywhere on the body should be investigated as soon as possible. So, if you notice a nodule on the palm of your hand, don’t postpone a visit to the doctor as it may or may not be related to Dupuytren's Contracture.
Your doctor may have you take a“tabletop” test. This involves to putting your hand, palm down on a table. If you cannot keep your palm flat on the surface of the table, you will probably receive a referral to a hand specialist or to a surgeon.
Dupuytren's Contracture cannot be fully treated. This means that the symptoms may go away forever, or they may reappear at some point in life.
There is no way of knowing if the treatment that you are receiving will help the disease to stagnate or clear it completely.
However, there are many treatment options that can make coping and living with Dupuytren's Contracture much easier.
For aggressive cases, in which the function of some digits is seriously affected, surgery is recommended as itwas proven to fully restore the range of motion.
There are two types of surgery that can be performed:
Surgery has a few disadvantages and risks like:
Even if the risks seem challenging, the procedures are usually safe and restore almost all the range of motion.
Sadly, there is no way of knowing if the condition will come back after surgery.
If the disease is in the early stages there are other non-invasive procedures that can improve the well-being of the patient.
Cortisone injections
This treatment involves injections around the nodules or thickened palmar tissue. The result is lowered inflammation, better mobility, higher level of extension and partial or total regain of function.
The result varies and depends on the initial stage of the disease and on other additional procedures.
Creams with anti-inflammatory properties
There is little research in this field, but there are natural remedies that were proven to have strong anti-inflammatory properties and which might be beneficial for people suffering from Dupuytren's Contracture.
Research showed that Arnica Montana has strong anti-inflammatory properties, in arthritis and post-surgical inflammation.
The effect on Dupuytren's Contracture isn’t yet fully understood or researched, but it may be of use to patients, especially those who have undergone and is now completely closed.
Aloe Vera alsoshowed anti-inflammatory benefits, along with vitamin E, which could be useful as ina study the participants have noticed improvements.
A cream that combines different natural remedies, could be used for massaging and stretching, after surgery or after different procedures like cortisone or enzyme injections.
Such a cream could be used also as a stand-alone treatment. You can find onehere.
Enzyme infiltrations
This is a relatively new treatment that is aimed at lessening the new, thickened tissue that causes the contracture. You can compare it to adding fabric softener to laundry.
It’s efficient, but the main problem will still persist, and the injections will probably need to be repeated at regular intervals.
Radiation therapy
Radiation therapy is sometimes recommended for Dupuytren's Contracture.
The principle by which it works is that the tissue that multiplies uncontrollably will be destroyed much like carcinogenic tissue, when exposed to radiation.
However, a recommendation for this type of therapy should be received with a dose of salt asstudies show that the risks might outweigh the benefits.
Radiation has the bad “habit” of destroying both cells that are out of control (like the ones that create the thick tissue that leads to Dupuytren's Contracture), and the healthy cells. This can lead to a series of other, unwanted problems.
Furthermore, there is very little evidence to support the use of radiotherapy, so unless you were recommended by a professional and obtained a second similar opinion, you should probably avoid this treatment.
Dupuytren's Contracture is a condition that affects your hands and your mood. So, if you feel marginalized or depressed due to this syndrome, ask for help and seek support.
There are many people with this or similar condition and building a support group is key in overcoming difficulties.
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