There are many types of treatment available to patients suffering from Dupuytren's Contracture. While some treatment options are surgical, others are less invasive. But before diving into the methods of treatment, it's important to understand the disease itself and what causes it.
Dupuytren's Contracture is a condition that affects the hands, or, more specifically, the fingers. It is characterized by the flexing of one or more fingers into a permanently bent position against the palm.
The condition develops over time, beginning with the hardening of the skin of the palm. With time, lumps of hard tissue gather on the surface of the palm. Eventually, these lumps stretch into bands of collagen, usually into the ring and pinky finger, but in some cases to all fingers. The skin hardens over time, bending the fingers into the palm and eventually restricting the bent fingers from re-straightening.
While Dupuytren's Contracture is not thought to be a particularly painful condition, it restricts the patient's hand's range of motion, which can be quite discomforting. In addition, the hardened palm skin becomes sensitive and prone to itching.
The exact cause(s) of Dupuytren's Contracture is not known. However, various research has led medical experts to determine a range of potential risk factors. For example, research published by theJournal of Bone ; Joint Surgery found that Dupuytren's Contracture is strongly associated with smoking and drinking alcohol.
Similarly,alternative research has found correlations between Dupuytren's Contracture and other medical conditions, such as epilepsy, diabetes, and trauma. It also notes that the condition is commonly agreed upon as hereditarily passed.
In terms of demographics, Dupuytren's Contracture mostly affects people of European descent, and it is found most often in men over the age of 50. The prevalence of the deformity in Northern European countries such as Norway, Iceland, and Scotland is the reason why Dupuytren's Contracture is often nicknamed 'the Viking Disease.' Other aliases given to the condition include 'Celtic Hand,' 'Morbus Dupuytren,' and 'Dupuytren's Disease.'
There are plenty of options available for Dupuytren's Contracture treatment. Choosing the right treatment depends on how aggressive the deformity is on a given patient.
Less invasive treatment options, such as radiation therapy and collagenase injections, are usually recommended for those who are in the early stages of the disease. Hand exercises are also considered to be helpful at this stage, as they help with blood circulation in the hand and can help improve its range of motion.
A promising treatment for Dupuytren's Contracture is by weakening and breaking the bands of collagen with a needle. This is known as needle aponeurotomy. Following this treatment method, patients' hands are usually back to normal by the next day after receiving treatment.
Similarly, collagenase injections aim to weaken and break the collagen bands in the palm through releasing collagenase enzymes, which break down collagen bonds. Once injected, the doctor moves the patient's hand, loosening the collagen bonds. Once the bonds are broken, the patient is able to straighten their fingers again.
It should be noted that with these treatment options, recurrence of the condition is common.
A commonly used technique for diagnosing Dupuytren's Contracture is the table-top test. The test requires the patient to place their hand flat down on the table. People with more severe cases of Dupuytren's Contracture are not able to lay their palm flat, and in these cases, surgery is commonly recommended.
Surgical treatment for Dupuytren's Contracture is advised when symptoms of the disease begin to disrupt everyday life.
When treating Duputren's Contracture surgically, there are 2 viable options. The first is known as a fasciotomy, wherein the hardened tissues in the palm are split up through small incisions. The second and most common option is a fasciectomy, wherein the lumps of tissue are completely removed from the patient's palm, allowing the fingers to move freely again.
While surgery may seem like a promising option to patients with Dupuytren's Contracture, it also has its downsides, such as the possibility of infection and skin damage. Which is why it is only recommended for patients with severe cases of the condition.
Opting for surgery is often the last resort for a patient with Dupuytren's Contracture. However, even with surgery, chances of recurrence of the disease are high. That being said, there are some advisory steps to take to care for your hand post-procedure.
Physical therapy is often prescribed to patients who have recently undergone a Dupuytren's Contracture treatment. This usually consists of hand exercises that promote movement of the fingers and discourage stiffness, such as spreading your fingers as far apart as possible, and then bringing them back together. On average, recovering patients undergo physical therapy for 2 to 4 months after-procedure.
In some cases, doctors also recommend wearing a hand brace or a splint, which helps stretch the tissues while healing and to prevent further contractions. Splints are usually worn by recovering patients for 6 to 12 weeks. Some patients are only required to wear a splint overnight, whereas others may be required to wear one all the time. However, it should be noted that research published by theUS National Library of Medicine claims that there is not enough conclusive data to determine the true effectiveness of splints.
In addition, recovering patients are advised to keep their affected hand elevated as much as possible. This helps in reducing swelling. It is also recommended to avoid smoking and consuming alcohol, as they are thought to aggravate symptoms and may hinder the recovery process.
Usually, the surgical stitches are removed within 2 weeks of surgery. After the wound heals, patients often find relief from scarring by massaging a soothing hand cream or lotion over the affected area.
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