Awareness of the signs and symptoms of Dupuytren’s Contracture continues to grow in the media as well as the medical industry. It is a condition that gradually causes the connective tissue, known as fascia, under the skin of a person’s palm to thicken over time. Eventually, these connective tissues develop a scar-like consistency.
As it progresses Dupuytren’s Contracture can lead to increasing loss of manual dexterity and decreased overall hand function. While Dupuytren’s Contracture might not be very painful, it increasingly restricts the movement of the affected hand.
The thickening connective tissues continue to force one or more fingers to curl toward the palm. This is usually the ring and pinky fingers. Though any finger can be affected by Dupuytren’s Contracture. As the thickening of the fascia progresses the contracture it causes can worsen. This could result in additional fingers on the same hand starting to curl in toward the palm.
The Challenges Of Living With Dupuytren’s Contracture
Left untreated, Dupuytren’s Contracture permanently bends the affected fingers into a fixed position. As the curl of contracture progresses it can become increasingly difficult to grasp large objects. Though even the early stages can make simple movements like washing your face or doing something as simple as putting on gloves.
Fortunately, Dupuytren’s Contracture usually doesn’t affect your ability to write and grasp small objects. This is because the thumb and index finger are rarely ever affected.
Unfortunately, this encourages some people to put off treatment for Dupuytren’s Contracture. This allows the permanent curling of the other affected fingers to worsen gradually over time.
What Causes Dupuytren’s Contracture?
If you were to thoroughly scour medical history, you would find that Dupuytren’s Contracture is not just a condition found in the modern age. In fact, it was first noted in medical literature fated back in the 1600s. Yet even with centuries of medical information and the advent of modern medical science, physicians still aren’t fully sure about what causes the scar tissue to form in the palm of the hand.
However, it seems that the prevalence of Dupuytren’s Contracture tends to run in families. This hints that there are likely some genetic factors involved. At the same time, Dupuytren’s is more common in middle-aged men. Especially those of Northern European descent. Other contributing factors can include alcoholism, tobacco use, diabetes, and even epilepsy.
What Are The Early Symptoms Of Dupuytren’s Contracture?
Dupuytren’s Contracture often starts out very mildly and might even go ignored in the early stages. The earliest symptoms tend to manifest as a thickening in the skin of the palm on one hand. As time goes on the skin might even start to look puckered as knots or nodules of hard tissue begin to form on the palm.
Early on these nodules might even feel tender to the touch, though they’re typically not painful. The thickening of the skin usually tends to progress very slowly. At this stage, most people don’t need treatment unless the symptoms are starting to bother them.
Advanced Symptoms Of Dupuytren’s Contracture
As Dupuytren’s Contracture starts to advance the nodules of tissue on the palm gradually stretch into thin bands of collagen. At this point, the hardened connective tissues progressively start to extend up, into the ring and pinky fingers. Over time the bands start to tighten, and gradually pull the fingers in toward the palm.
This can make it difficult to straighten out the affected fingers. While Dupuytren’s Contracture can sometimes affect both hands it is usually that one hand is usually worse than the other. The contracture of the collagen bands is so strong that it permanently traps the hands in the enclosed position with such strength that the opposing extensor muscles of the fingers prevent you from returning the fingers to their straightened position.
How Is Dupuytren’s Contracture Diagnosed?
Diagnosing Dupuytren’s Contracture typically starts with your physician examining your hands to feel for thickened scar tissue and the telltale collagen bands. They will also assess whether your fingers pull inward. This physical examination might also include what some call a “Table Top Test” where you attempt to put your hand, palm down, on a table and try to get it to lay flat.
If you absolutely cannot get the hand to lay flat, then your Dupuytren’s Contracture may have progressed to the point that it requires surgical intervention. Your physician might also test your grip and the range of motion in your fingers.
Nonsurgical Treatments For Dupuytren’s Contracture
If possible, your physician might be able to treat a mild to moderate case of Dupuytren’s Contracture without invasive surgical intervention. This might start with strategically placed corticosteroid injections to help reduce any pain and inflammation. This might also help slow the progression of the disease.
Your physician might also be able to inject enzymes into the palm of the affected hand to help weaken the collagen bands. At that point, your hand is slowly moved by the physician until the bands are broken and your fingers can be naturally straightened.
Other possible treatment options might include needle aponeurotomy, where the contracted bands are divided with small hypodermic needles. Currently, Radiation therapy is also being studied as a treatment and has been successful in several small studies.
Surgery Intervention For Dupuytren’s Contracture
If you have a more severe case of Dupuytren’s Contracture to the point that your symptoms are severe enough to interfere with daily life, your physician might recommend surgical intervention.
This is an outpatient procedure where your surgeon removes the thickened collagen tissue in your palm, to allow your fingers to move again. This surgery can usually often restore normal movement, but there is a risk of potential nerve damage in the hand.
Recovering After Dupuytren’s Surgery
Once your surgically altered hand has fully healed, you will likely need to engage in physical therapy for a few months. Your physical therapist will teach you a series of exercises to help you restore the functional strength of your hand and the fluid movement in your fingers. Just bear in mind that even with successful surgery, Dupuytren’s contracture can return, and you should notify your physician if you notice early symptoms recurring.