Fingers, most commonly ring and little fingers, become bent, making activities involving the hand difficult. One or both the hands can be affected. Rarely it can be inherited.
Stages of Dupuytren Contracture
Dupuytren contracture is graded into 6 stages depending on the degree to which the fingers are bent. N stage shows only nodules/cords. N/1 stage show very little, if any, contracture (0 to 5 degrees).
First stage shows 6 to 45 degrees contracture; second, 46 to 90 degrees contracture; third, 91 to 135 degrees contracture; and the fourth stage, more than 135 degrees contracture.
Symptoms of Dupuytren Contracture
The contracture shows slow progression over years. Sometimes it can develop rapidly in a matter of weeks or a few months. In some, the progression may be arrested in the very early stages itself. Early on, skin of the palm is thickened leading to puckering or dimpling.
A lump may form close to the base of fingers, which is firm but usually painless. Later, the cords or lumps tighten, pulling the affected fingers toward the palm. Any finger can be affected, though it is common in ring and little fingers. If both hands are affected, the severity may vary from one hand to the other.
Causes and Risk Factors
Cause is not known. Autoimmunity, that is, one’s immune system attacking one’s own tissues, is speculated as one of the causes. There may be contractures elsewhere in the body, like in the feet or penis. It is more common in those having diabetes or epilepsy. Smoking and alcoholism are predisposing factors. Typically, it occurs in males over 50 years. Genetic predisposition is present.
If index finger and thumb are spared, which is usually the case, there is very little inconvenience and fine motor activities like writing are not affected. Use of hand is affected, making grasping with hand or reaching into narrow spaces difficult. Dressing is impaired.
A doctor will usually do the tabletop test. The test is to see if you can lay your palm flat on a table. If so, you do not have Dupuytren contracture. In addition, hand needs to be checked for puckering and toughened areas of skin on the palm. X-rays or other tests are unnecessary.
Dupuytren Contracture Treatment
If the disease is mild with no functional impairment of the hand, then no treatment is necessary or simple measures like finger stretching, massage, application of heat and wearing of padded gloves when holding objects suffice.
However, progression of the disease has to be watched for. If symptoms are interfering with the use of hands, collagenase and/or cortisone injection is helpful to break up the scar tissue. Surgery may be necessary if the problem is severe, wherein the cords or bands of fibrous tissue need to be broken apart.
This can be done by ultrasound-guided needling, i.e., using a needle to break apart the offending tissues. It can be repeated if the problem recurs. Sometimes, the scar tissue may need to be removed. This needs to be followed by physiotherapy. There are no preventive measures for the contracture, but treatments are most often effective.
Photo Credit: Cyfairhandandwrist.com/dupuytrens-contracture.aspx