Dupuytren’s Contracture Treatment, Causes, and History
Dupuytren’s disease (sometimes erroneously termed ‘Viking disease’ because of its prevalence in Scandinavian populations) is a relatively rare condition that affects the palmar fascia, which is the layer of tissue found under the skin of the palm. The disease causes the fingers to curl toward the palm and can make daily tasks, particularly those requiring manual dexterity, more challenging.
What Is Dupuytren’s Disease?
If you look at your hand, it is easy to see that the palm is very different from the back of the hand, where the skin is much looser. The skin grips the palmar fascia on the palm side and allows us to grasp and hold objects with a high level of dexterity.
The fibrous part of the fascia is held together by collagen. For those with Dupuytren’s disease, the normal process of replacing old collagen with new does not happen the way it should. This results in a buildup of collagen under the skin in the palm.
This buildup causes the formation of lumps in the palm of the hand. These lumps eventually turn into cordlike bands that affect the ability of the fingers (usually the little finger and ring finger) to move, causing them to pull in toward the palm. Once this happens, the condition is usually referred to as Dupuytren’s contracture.
There are treatment methods which can soften or break apart the tissue, but without treatment, Dupuytren’s contracture usually becomes permanent at this point.
What Causes Dupuytren’s Disease?
Although the disease has existed in formal medical literature for nearly two centuries, the exact cause of Dupuytren’s disease is still unknown. Researchers have identified a number of factors they believe can contribute to the development of Dupuytren’s, including:
- Advanced age
- Heredity: Dupuytren’s contracture tends to appear in successive generations, often in families with Scandinavian or other European ancestry
- Sex: Men are almost four times as likely to develop the condition as women
- Health: Some medical conditions, such as diabetes and seizure disorders, are related to higher rates of Dupuytren’s disease
- Tobacco and alcohol use: Smoking and consuming alcohol appear to increase the risk of Dupuytren’s contracture
Symptoms of Dupuytren’s Contracture
Dupuytren’s contracture is characterized by a number of notable, unique symptoms:
- An inability to lay your palm flat on a surface (this is called the tabletop test)
- The appearance of tender lumps, or nodules, on the palm of your hand
- The development of thickening bands of tissue from the palm to the fingers
- Fingers that curl either inward, toward the palm, or sideways toward one another
What Treatments Are Available for Dupuytren’s Contracture?
While there is no cure for Dupuytren’s contracture, treatment options, ranging from medication to surgery, are available. Most of these options are likely only to provide temporary relief.
- Steroid shot. Injections of steroids can be used if you have painful lumps in the palm.
- Enzyme injection. Your doctor will numb the area and then inject an enzyme which can help break down and soften the bands of tissue causing your fingers to contract. In the second part of this treatment, your doctor will then manipulate or break the bands, releasing your palm.
- Needle aponeurotomy. The area is numbed and then a needle is used to repeatedly divide the tissue in the bands.
- Radiation therapy. Low-energy radiation is aimed at nodules in the palm, which helps soften them and can prevent contractions from occurring.
- Surgery. Surgery is the most invasive of the treatment options for Dupuytren’s contracture, and is often used if the condition has progressed to an advanced stage. Your surgeon will create an incision in the palm and cut the bands of tissue, which releases your fingers into their usual position. This is not a permanent solution, as the bands can develop again later.
Quality Care at South Island Orthopedics
At South Island Orthopedics, our physicians are committed to more than just treating your symptoms. We believe that each patient is best served through an integrative treatment plan. We focus on providing both surgical and non-surgical evidenced-based solutions tailored to your specific condition and needs.
If you’d like more information about Dupuytren’s contracture treatment, click here to schedule an appointment.
Posted in: Hand & Wrist