Causes and treatment of Dupuytren's contracture.

Dupuytren's contracture is a condition that causes compression or contracture of the palmar fascia, the connective tissue found under the skin in the palm of your hand. The contraction can cause the fingers to constantly bend and impair the function of the hand.

The palmar fascia is a thick tissue located above the tendons and under the skin of the arm. The fascia attaches both to the skin on the top and to the structures on the bottom. The palmar fascia provides a firm grip surface for the hand and fingers.

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Causes

No one knows exactly what causes Dupuytren's contracture, but it is well known that it runs in the family: Between 60 and 70 percent of people have a family history of the condition. Other factors that cause Dupuytren's contracture, such as trauma, diabetes , alcoholism, epilepsy, and liver disease , are suspected, but there is no clear relationship.

The disease occurs most often in older men (usually after age 40) (more often than in women) of Northern European descent. One of the frequently mentioned groups is people with Viking ancestry, and this can be called Viking disease.

There is evidence that trauma may contribute to the development of Dupuytren's contracture. It was investigated whether specific traumatic events or a history of manual labor can contribute to this problem. Microscopically, there is evidence of bleeding in the affected tissues, suggesting that trauma may contribute to this condition. However, Dupuytren's disease is often seen in both hands and is as common in both dominant and non-dominant hands, evidence that the problem is not the result of repeated trauma.

What to expect

The first clinical signs of Dupuytren's contracture are usually small, painless nodules on the palm of the hand. The nodules may begin to merge and the skin wrinkles. Finally, in the later stages of the disease, the skin and underlying fascia shrink, causing dysfunction in the hands and fingers. In people with Dupuytren's contracture, the fingers are bent toward the palm.

Although all fingers can be affected, Dupuytren's contracture most commonly affects the ring and little fingers. The development of Dupuytren's disease tends to be rapid bursts followed by periods of small changes. Dupuytren's contracture is rarely painful, but it can be very unpleasant. Dupuytren's disease is usually limited to the arm, but it can affect other parts of the body as well, most commonly the soles of the feet. About five percent of patients with Dupuytren's contracture also have a similar condition of the soles of the feet, called Lederhosen disease.

Dupuytren's contracture against the disease.

Most people, including doctors, use these terms interchangeably. Technically speaking, Dupuytren's disease refers to the proliferation of cells that cause the formation of nodules and contractures. Dupuytren 's contracture is the result of this cell proliferation and a frequent manifestation of Dupuytren's disease. Treatment for Dupuytren's contracture may be considered when the condition causes difficulty in performing normal daily tasks.

Prognostic factors

Inheritance The history of this condition in your family indicates that it will be more aggressive.
Sex Dupuytren's disease usually starts later and progresses more slowly in women.
Alcoholism or epilepsy These conditions are associated with Dupuytren's disease, which is more aggressive and more likely to recur.
Disease location When both hands are present, or when there is an associated injury to the foot, progression tends to be faster.
Behavior of the disease

More aggressive Dupuytren's disease is more likely to return after surgery and remain aggressive.

For many years, treatment in the early stages of Dupuytren's contracture was a waiting situation. Because the surgery is invasive and may require long-term recovery and rehabilitation, it was often used as a last resort if symptoms began to interfere too much with daily activities.

Recently, the use of less invasive treatments has raised some hope that Dupuytren's contracture can be managed well, especially if it is treated at an early stage of the problem. We know that the worse the contracture, the more difficult it will be to restore normal function to the arm. Therefore, many people seek less invasive treatments, especially for the early stages of Dupuytren's contracture.

Watch out

There are currently four main treatment options for Dupuytren 's contracture:

  1. Observation: Observation is often seen at the beginning of Dupuytren's contracture. This is usually the best option for people with a normal manual function. They can be people with minimal contracture or people who do not use their hands and can do all their normal activities.
  2. Needle aponeurotomy: Needle aponeurotomy is a procedure developed in France that has only recently become more popular in the United States. Without incisions, a needle is used to cut the ligaments of Dupuytren and restore some or all of the movement of the fingers. Needle aponeurotomy is most successful in the early stages of Dupuytren's contracture.
  3. Collagenase Injections : Collagenase is an enzyme produced by bacteria that is injected into Dupuytren's umbilical cord. The enzyme dissolves the dense tissue of Dupuytren. The day after the injection, after the enzyme has done its job, you will return to the doctor to manipulate the finger to destroy the tight tissue and restore the mobility of the finger.
  4. Surgery: An operation is performed to remove the palmar fascia from the palm of the hand. Surgery can be effective in restoring function and may be necessary in the later stages of Dupuytren's contracture. The operation usually has a long rehabilitation period.

Operation

For some patients, less invasive treatments may not be appropriate. Also, not all doctors know that needle aponeurotomy is a treatment option for Dupuytren's contracture. There is controversy over the use of this treatment, and therefore not all clinicians recommend needle aponeurotomy. If you want to discuss needle aponeurotomy with your doctor, you can find a list of doctors who perform this procedure on the Dupuytren's-Online website .

The surgical procedure for Dupuytren's contracture is known as a fasciectomy, which removes segments of the palmar fascia. The downside of the operation is that it involves significant risks. Most commonly, scar tissue can form after surgery, resulting in a problem similar to Dupuytren's contracture, but with the formation of scar tissue. In addition, Dupuytren may return and the reoperation is fraught with problems. Other problems with surgery include nerve damage, infection, and long-term healing.

Rehabilitation

Rehabilitation after needle aponeurotomy is relatively quick. Usually patients can return to their normal activities immediately and are advised to refrain from sports and heavy work for about a week. Depending on the type of contracture, the removable splint can be worn for several hours every day.

Rehabilitation after surgery varies significantly. Patients with minimal contractures can return to normal activities after the incisions have healed for several weeks. More severe contractures may require months of splinting and rehabilitation with a hand therapist to prevent scar tissue from forming.

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