Dupuytren's disease affects the fascia (fibrous tissue) found under the skin of the fingers and palm. Dupuytren's disease causes an irregular thickening of the fascia. The thickening causes the development of hard lumps or thick bands, which over time may lead to one or more fingers flexing (contracting) and pulling toward the palm. The flexing (bending) is referred to as Dupuytren's contracture, and it mainly affects the pinky and ring fingers.
Dupuytren's contracture will affect both hands and, in some rare cases, toes too. The contracture is rarely a source of pain, but the severe disease may interfere with normal hand function. This disease is one which will occur over a longer period of time and many people may just not recognize that it’s occurring as the signs come on so slowly.
How Dupuytren’s Contracture Develops
Fascia (connective tissue) serves to stabilize and anchor skin found on the palm, making it taut and functional. However, when patients start developing Dupuytren's disease, the palmar connective tissue slowly thickens and becomes tight.
Detection of Dupuytren's disease will become possible when lumps or nodules of tissue can be felt beneath the skin of the palm. The formation of pits may then follow lumps on the palmar surface as the affected tissue pulls the overlying skin.
The disease progression causes the tissue bands to form thick rope-like structures that tether a finger or more fingers into a flexed position. The rope-like structures may resemble tendons, but tendons are not culprits in Dupuytren's contracture.
Dupuytren's contracture develops slowly, often over a couple of years, and can remain mild to the extent treatment is not necessary. The moderate or severe form of disease makes it hard to straighten the fingers involved. The latter may necessitate treatment to reduce the contracture and improve the finger's field of motion. Worsening of the contracture leads to more destruction of the underlying connective tissue dampening the chances of treatment causing full correction of the condition.
What Causes Dupuytren’s Contracture?
As is with quite a handful of medical conditions, the cause for Dupuytren's contracture is still not very clear. However, genetics have been implicated as major predisposing factors. Contrary to the rumors peddled, there is no direct correlation between hand use or overuse and Dupuytren's contracture. Some reports may have indicated that injury to the hand or open wounds may later lead to Dupuytren's disease, but there is still no confirmable evidence directly linking the two.
There are risk factors believed to contribute to a person developing the disease or lead to worsening of the disease in an affected patient. These are:
- Gender. Men have increased susceptibility as compared to women
- People of Scandinavian and Northern European ancestry
- People with a positive family history of the disease
- Smokers and alcohol users
- People on anti-seizure medication and diabetics have an increased risk
- Older people are at an increased risk
Disease Presentation
As earlier established, disease progression is slow. Signs and symptoms are:
Developing nodules - Small lumps develop under the skin of the palm. The nodules are fixed to the skin of the palm. The nodes are tender initially, but the tenderness wears off with time, and there may be a deep indentation of the skin's surface close to the lumps.
- Developing cords - The nodules become thicker and contract, leading to tough and dense cords of connective tissue beneath the skin. The cords restrict and tether fingers, including the thumb, and prevent them from straightening or separating.
- Developing contractures - The tightening skin pulls the affected fingers towards the palm, restricting them from spreading apart or straightening out. The knuckle joint is most affected, but other joints may also be affected.
Treating Dupuytren’s Contractures
No cure exists currently for the condition. However, as the condition worsens, the doctor may start with a nonsurgical intervention to prevent disease progression. Nonsurgical intervention includes:
- Injections of medications to the affected area - Anti-inflammatory medications are used to help deal with pain and to slow disease progression. Results are patient-specific.
- Radiation Therapy - Radiation in the form of low-energy X-rays is directed at nodules. Therefore, radiation therapy has the best prognosis in the early disease stages and helps soften nodules.
- Injection of Enzymes - Enzymes are injected into the numbed hand and dissolves and breaks down the cords. Finally, the doctor cuts the cord, and the finger straightens.
- Needle aponeurotomy - The arm is numbed using a local agent. The doctor then uses a needle to divide the affected tissue.
Surgery is preferred for advanced disease. The surgeon makes an incision on the hand and cuts out the affected tissue. Additionally, the surgery improves finger mobility. Contractures may reoccur, necessitating another bout of surgery.
In conclusion, Dupuytren's contractures are not very aggressive and develop over many years. They cannot be healed but can be managed when medical intervention is sought when finger mobility is affected.