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What Is Dupuytren's Contracture

October 18, 2020

Dupuytren's Contracture, also known as Dupuytren's Disease, is a condition that affects the fiber tissue underneath the skin of the palm of the hand and fingers. Patients with this condition cannot completely straighten their fingers as they get stiffed into a bent position towards the palm of the hand.

The Dupuytren's Contracture usually starts with small hard knots of tissue forming in the palm of the hand, under the skin, creating a thick cord that with time worsens until the patient can no longer move and straighten the fingers.

In more serious cases, the condition can affect the patients entire hand mobility, making it difficult for them to make elementary hand movements, forcing a change in their daily routine and making it a challenge for them to perform simple actions, such as holding things, cooking, writing, putting their hands in their pockets, and shaking hands with other people.

Detailed Description

Under the palm of the hand, there's a thick layer of tissue called fascia that holds and stabilizes the skin in its place. The fascia is important as it keeps the skin on the palm of the hand loose, even as you move your fingers and hands into different positions.

Patients withDupuytren's disease have the fascia affected, as this tissue starts to thicken and tighten with the formation of anomalous lumps or nodules and the patient starts to notice some hand mobility issues and difficulty straightening their fingers.

As the condition progresses, those hard and thick lumps develop into cords — that look like tendons, but they have no correlation to Dupuytren's disease — and one or two fingers get completely bent. This stage of the disease gets the name of The Dupuytren's Contracture, as the patients fingers get contracted and lose the ability to straighten back out. 

Overall, the disease progress is slow and normally takes years from the patient starting to notice the first symptoms until it develops into cords. Any finger can be affected, but normally the two fingers farthest from the thumb, the ring, and little fingers, are the most affected.

In some cases the Dupuytren's Contracture can stay light, so no treatments are necessary. In moderate cases the treatment is recommended to give the finger's motion back to the patient and prevent the contracture development. In more severe cases, when the fascia becomes completely thick and stiff, the treatment may not help to correct the fingers bent position.

Risk Factors

There are several factors that are believed to aggravate the development of Dupuytren's Contracture or make it more severe:

  • Gender:this factor plays an important role in the condition as men tend to have it more than women.
  • Heredity:heredity is another crucial factor as the Dupuytren's Contracture usually runs in the family and passes from one generation to the other. 
  • Age:there's no evidence of certain age groups being more prone in the disease's development, but normally the cases get more severe with age. 
  • Tobacco and alcohol: smoking and drinking alcohol are directly associated with Dupuytren's Contracture development, as they affect the blood vessels.
  • Ancestry: Scandinavians (Sweden, Finland, and Norway) and the population from Northern Europe (England, Irland, France, and Netherlands) are the most affected by the disease. Because of that, centuries ago, Dupuytren's Contracture used to be called "The Viking Disease". Meanwhile, there are almost no reported cases of the condition in those of Chinese and African descent. Which makes ancestry an important factor.
  • Diabetes: patients with diabetes or a higher concentration of glucose levels in the blood are more likely to develop the condition and have it more severe.

Dupuytren's Contracture Symptons

Although the condition develops very slowly and it may take years to start progressing, there are a few symptoms that patients can start noticing during its earlier stages. The sooner theDupuytren's Contracture gets diagnosed the more effective the treatment to restore motion will b.

These are some of the most common symptoms: 

Appearance of Nodules 

The very first symptom or sign of Dupuytren's Contracture is small hard nodules forming in the palm of the hand. They are normally underneath the skin and cause no pain. In some cases, the skin around the nodule gets irregular and the patient can feel some itching or irritation.

Development of Cords

After the appearance of the first nodules, they'll start to thicken and contract deeper into the palm of the hand, which causes the formation of tough cords underneath the skin. Those cords are made of hard tissue and will inhibit the fingers straightening, motioning, and make it harder to spread them apart.

Inability to Straighten the Fingers

The affected fingers get bent and pulled towards the palm of the patient's hand and the mobility gets inhibited. Any finger can be affected, but most cases happen in the ring and the little fingers. The fingers first joints looses their movements.

Diagnosing Dupuytren's Contracture 

As the first symptoms appear, the doctor will first ask about possible risk factors that the patient may have, especially the ones related to heredity, to see if the condition runs in the family and other medical conditions that may contribute. Then they will start physical examinations of the fingers.

The doctor will see where the nodules are located in the palm of the hand and start tracking the range and motion of the fingers. Then, they will record the size and the patient's ability to move his fingers so those can be observed over time to see if the condition is developing and at what speed.

Another possible examination is the "table-top" exam, in which the doctor will ask the patient to put his hand on top of a table, palm down, to see if it lays flat. This way, it's also possible to track the range of motion and the ability to straighten the fingers. Gripping big objects can also be a type of test to diagnoseDupuytren's Contracture to check if the condition is affecting the patients force.

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