DUPUYTREN'S CONTRACTURE: Cause, Risk factors and Treatments

OVERVIEW

 Dupuytren's contracture is a deformity of the hand that causes one or more fingers to bend in towards the palm. The ring and little finger are the most affected and it can be so severe that everyday activities may become difficult. Other names by which the disease is known include: Morbus dupuytren, Dupuytrens disease, Vikings disease or Trigger finger. This disease majorly results when Collagen Type I that makes up the Palmar fascia changes to Collagen Type III which is much thicker resulting in the formation of nodules and taut cords. Causes/risk factors include: hereditary, ancestry, autoimmune reaction, sex and age etc. Treatment focuses on removing or breaking these cords apart using techniques such as enzyme (collagenase) injection, needle aponeurotomy and surgery

Dupuytren's Contracture: Finger(s) bend inwards toward the palm

Dupuytren's contracture is a slow developing and often painless deformity of the hand that causes one or more fingers to bend in towards the palm and can not be fully extended or straightened.

The disease is also known as Morbus Dupuytren or Dupuytren's disease and is named after Baron Guillauine Dupuytren, the surgeon who first described an operation to correct it. It mostly affects the ring and little finger. The middle finger may be affected in advanced or exclusive cases. But it rarely occurs in the index finger or thumb.

This disease can be so severe that everyday activities such as putting on gloves, placing hands in your pockets, typing, or shaking hands can become difficult

DID YOU KNOW THAT APPENDICITIS IS CURRENTLY ONE OF THE MOST COMMON AND SIGNIFICANT CAUSES OF SEVERE AND ACUTE ABDOMINAL PAIN WORLDWIDE

CAUSES

The exact cause of Dupuytren's contracture is not known for sure. However, there are possible causes and risk factors. These include:

• Autoimmune reaction: It may be associated with an autoimmune reaction, where a person's immune system attacks its own body tissues
• Hereditary: Dupuytren's disease runs in families and, as such, can be inherited. 60-70% of individuals with the disease have a family history of the condition
• Ancestry: The disease is most common in people of Northern European or Scandinavian ancestry
• Sex and age: The disease is much more common among men than women. Also in men, the occurrence rate increases after the age of 40
• Other conditions: The disease sometimes occur together with some other conditions that causes contractures in other parts body such as the penis or feet. Also, alcoholism, diabetes, trauma, etc can trigger the disease

WHAT REALLY HAPPENS/SIGNS AND SYMPTOMS

There is a layer of connective tissue, called the Palmar fascia, just under the skin of the palm. This tissue is attached both to the skin above and to structures below. It helps provide a tough, gripping surface for the hand and fingers. Normally, the Palmar fascia contains a kind of collagen called Collagen Type I. But if someone has Duputren's disease, the Collagen Type I changes to Collagen Type III which is much thicker. This abnormal change causes the Palmar fascia to:

• Develop nodules: Small, painless nodules or lumps form in the palm

• Develop taut cords: The nodules come together, contract, thicken and shorten to form taut cord close to and at the base of the fingers

• Bend inwards toward the palm: The flexor tendons connected to the fingers lose the ability to move freely and, instead, bend inwards toward the palm

Structure of the Palmar fascia

The main function of the palmar fascia is to increase the grip of the hand. Thus, over time, Dupuytren's contracture decreases patients' ability to grip objects effectively

Dupuytren's contracture can be diagnosed by simply carrying out the table top test. In this test, the patient places his hand on a table. If the hand lies completely flat on the table, the test is negative. But if the hand cannot be placed completely flat on the table or there is a space between the table and a part of the hand as wide as the diameter of a pen, then the test is positive and treatment should be commenced

YOU THINK ONLY BONES FRACTURE? EVEN THE PENIS FRACTURES TOO!

TREATMENT

Treatment measures of Dupuytren's contracture aim at removing or breaking apart the cords pulling the fingers in toward the palm. There are different ways to do this. However, the choice of treatment depends on the severity of the disease. They include:

Needle Aponeurotomy:

In this treatment, a needle is inserted through the skin on the palm and use to break the thick cord of tissue that is contracting the finger. This method does not require any incision and it can be done to several fingers at the same time. Also, little or no physical therapy is needed afterward. However, its major demerit is that it cannot be used in some locations in the finger so as to prevent a nerve or tendon damage. Also, contractures often recur but the procedure can still be repeated

Enzyme Injection

This treatment involves injecting the enzyme, Collagenase (Xiapex) into the taut cord in the palm to soften and weaken it - allowing a doctor to manipulate the hand in attempt to break the cord and straighten the fingers.

Surgery

Most patients turn to surgical treatment when the functions of the hand is severely limited by the disease. Surgery for Dupuytren's contracture aims at removing the diseased and thickened tissue in the palm. This may be a challenging task because the diseased tissue may attach to the skin making it difficult to completely remove, thereby increasing its chances of recurring. In order to prevent this, in some severe cases, all the tissue likely to be affected including the attached skin are removed. In such cases, a skin graft will be needed to cover the open wound.

*Skin graft(ing): This is a surgical procedure that involves removing skin from one part of the body (called the donor site) and transplanting or using it to cover another part of the body. *

The major advantage of surgery is that it results in a more complete joint release than that provided by the needle or enzyme treatments. Its main disadvantages are that physical therapy is usually needed after surgery and the recovery time can be longer

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