Dupuytren's Contracture

Dupuytren's contracture is a chronic condition that affects the palmar fascia, a layer of connective tissue beneath the skin of the palm. It is characterized by the formation of nodules and thickened cords in the palmar fascia, which can cause one or more fingers to bend into the palm, resulting in a flexion contracture.

Causes and Risk Factors

The exact cause of Dupuytren's contracture is not fully understood, but it is believed to be related to a combination of genetic, environmental, and hormonal factors. Some risk factors that may contribute to the development of Dupuytren's contracture include:

• Age: Dupuytren's contracture typically affects people over the age of 50
• Sex: Men are more likely to develop Dupuytren's contracture than women
• Genetics: There is a strong genetic component, with many cases running in families
• Diabetes: People with diabetes are at increased risk of developing Dupuytren's contracture
• Smoking and alcohol consumption: These habits may contribute to the development of Dupuytren's contracture

Symptoms

The symptoms of Dupuytren's contracture can vary in severity, but typically include:

• Nodules or lumps in the palm, which may be tender to the touch
• Cords or thickened tissue in the palm, which can cause the fingers to bend into the palm
• Flexion contracture of one or more fingers, resulting in an inability to fully straighten the finger
• Pain or discomfort in the palm or fingers
• Difficulty performing daily activities, such as grasping or gripping objects

Treatments

Treatment for Dupuytren's contracture depends on the severity of the condition and may include:

• Observation: For mild cases, observation and monitoring may be recommended to see if the condition progresses
• Corticosteroid injections: Injecting corticosteroids into the nodules or cords can help reduce inflammation and slow disease progression
• Collagenase injections: Injecting collagenase, an enzyme that breaks down collagen, into the cords can help dissolve the thickened tissue
• Surgery: Surgical removal of the affected tissue (fasciectomy) or release of the contracted tendon (tenolysis) may be necessary for more severe cases
• Physical therapy: After surgery, physical therapy can help improve range of motion and strength in the hand and fingers
• Splinting: Wearing a splint at night to stretch the affected finger(s) can help maintain flexibility and prevent further contracture

Complications and Prognosis

If left untreated, Dupuytren's contracture can lead to significant disability and impairment in daily activities. Complications may include:

• Persistent pain or discomfort
• Loss of range of motion and flexibility in the hand and fingers
• Difficulty performing daily activities, such as dressing or feeding oneself

With proper treatment, many people with Dupuytren's contracture can experience significant improvement in symptoms and function. However, recurrence is common, and ongoing monitoring and treatment may be necessary to manage the condition.