Dupuytren's contracture: causes, symptoms and treatments

Dupuytren's contracture is a deformity that affects the hands and, in particular, the movement of the fingers. This disorder disrupts the layer of tissue under the skin of the palm of the hand. It progresses over the years and is more common in males after 45 years of age.

In half of the people who have it, the disorder affects both extremities. When only one hand is affected, the frequency of the right hand is twice that of the left.

The contracture limits the movements of the fingers and prevents them from being fully stretched, which complicates daily activities. It manifests itself in the ring and little fingers, especially.

Some of the more limited movements are putting your hands in your pockets, putting on a pair of gloves, or saying hello. Below we explain more about this affectation called Dupuytren's contracture.

Related symptoms

Most often, Dupuytren's contracture progresses slowly. Over time, the disease will reduce the functionality of the affected hand.

Starts with a thickening of the skin on the palm of the hand. Later, the skin of the palm becomes wrinkled or with depressions on the surface. A small nodule may also appear, in the same area.

This nodule increases in thickness until it forms a band, similar to a cord. It may be tender to the touch, but it is not painful. The formation of the same under the skin pulls one or more fingers, keeping them flexed. This position it is the cause of the hand looking like a claw.

There are movements that become impossible with this disease and that limit daily life.

What is the cause of Dupuytren's contracture?

The specific cause of Dupuytren's contracture is unknown.. It is considered to have a hereditary component that affects males.

There is no evidence that hand injuries will recur in the future. Nor can it be guaranteed that activities or jobs with vibrations can cause them.

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Risk factor's

Dupuytren's contracture occurs with different frequency depending on the genetic load and characteristics of the people. A higher frequency has been observed in people with alcoholism or epilepsy.

This alteration is more common in northern European countries and in those who come from those areas. In contrast, it is a rare disorder in Africa and East Asia.

Among the risk factors for suffering from it are the following:

  • Age: after 50 years.
  • Sex: 7 to 10 times more common in men than women.
  • Family background: Dupuytren's contracture tends to run in families.
  • Diabetes: people with diabetes are at higher risk, apparently from chronic collagen damage.
  • Tobacco and alcohol consumption: smoking is associated with an increased risk of it, due to microscopic damage to blood vessels. Alcohol consumption is associated with this contracture due to toxic metabolites and liver damage.

Available treatments for Dupuytren's contracture

One of the initial phases of treatment is keep mild and non-progressing cases under observation. This initial measure can be considered because it does not limit functionality.

Corti injectionssona within the nodule can reduce sensitivity if performed before the fingers have started to curve. It is important to mention that cortisone does not slow the progression.

Another treatment option is with collagenase injections., which has favorable results. Collagenase is an enzyme that dissolves the collagen that forms the taut cord of the palm.

The substance used is produced by the bacteria Clostridium histolyticum. By applying the enzyme, the fibrous cord can soften and weaken, allowing the hand to be manipulated and breaking the cord to straighten the fingers.

Radiation therapy (radiotherapy) is used in some European countries. With this technique a good response is obtained, because it delays the progression of the disease and the need for a surgical approach. It is usually only done once.

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Puncture

The puncture technique can be used before surgical treatment. In it is use a needle what it is inserted through the skin. The goal is to break the cord of fibrous tissue what contract your finger.

The advantages are that it does not require a surgical incision and can be done on several fingers at the same time. After doing it, little physical therapy is needed. Its disadvantage is that contracture reappears.

Surgical treatment

Surgery is reserved for cases in which the palm of the hand can not supportass of form flat on a table. Also when the fingers are so bent that function is limited or if several fingers are affected.

The main objective is to surgically remove the tissue affected by the disease. The main advantage of the surgery is that the results are more complete and lasting than those obtained with the injection of collagenase or with the puncture.

In cases serious, It will be looked for remove all tissue affected by contracture of Dupuytren, including the skin that is attached to the fibrous. Se therefore needs a skin graft to cover the wound.

The postsurgical process in this pathology is long and requires rehabilitation to regain functionality.

Tips and prevention

For people who suffer from a Dupuytren's contracture, it is recommended to make the following changes in their activities:

  • Protect hands with gloves padded for lifting heavy objects.
  • Placing pipe insulation or padding tape on the handles of objects and tools.

Physical therapy also helps reduce pain and increase the ability to move. The following techniques can be used:

  • Heat therapy.
  • Ultrasound.
  • Extension movements.

Dupuytren's contracture is progressive

Dupuytren's contracture can progress unpredictably. It causes deformity and loss of function of the affected hand. For this reason, it is very important to observe it and maintain adequate medical control.

In cases that require surgery as treatment, it is complemented with physiotherapy. In this way, they can lessen symptoms and make the hand work better. The goal is always to increase the mobility of the fingers.