Dupuytren’s Disease/Contracture
Also known as Dupuytren’s disease, this condition causes nodules or knots to form underneath the skin of your fingers and palms. This is the result of abnormal thickening and tightening of the fascia. In most cases, the ring and little fingers of both hands are affected. The fascia contains strands of fibres that run upwards from the palm to the fingers. The fibres tighten or contract in patients suffering from Dupuytren’s contracture, causing their fingers to curl forward. In severe cases, or if left untreated, this condition can lead to hand deformities that compromise hand function.
Causes
Unlike the other hand conditions, Dupuytren’s contracture is not caused by injuries or overuse of the hands. While the cause is still unknown, certain medical conditions or lifestyle habits may increase the risk of patients developing this condition:
- Diabetes
- People who drink a lot of alcohol
- Having a relative who suffers from this condition
- Male over the age of 40
Signs And Symptoms
The signs and symptoms of Dupuytren’s contracture often show up in phases, with most patients noticing small lumps under the skin of the palm at first. The lumps or nodules may feel tender and sore initially, but the discomfort goes away after a while.
Over time, thick bands of tissue will extend from the nodules towards the fingers, and eventually tighten, causing the affected finger to be pulled towards the palm. As the curling worsens, it becomes more difficult for patients to straighten their fingers. Hence, patients suffering from Dupuytren’s contracture often struggle to pick up large objects, shake hands or even wear gloves.
Diagnosis
Your hand surgeon will usually examine your hands for any lumps or nodules, and also assess your grip strength and ability to pinch. The tabletop test is usually done. This requires you to place your fingers flat against the tabletop, and patients who have Dupuytren’s contracture are usually unable to perform this task successfully.
Treatment
While there is no cure for this condition, there are still treatments available. The goal of treatment for Dupuytren’s contracture is to reduce the symptoms and the extent of disability caused by the disease. One such treatment would include needling. Needling is a procedure involving the use of needles to break the cords apart. The advantage of this procedure is that it has a short recovery period and can be done multiple times if the contracture comes back.
Another treatment option would be enzyme (collagenase) injections to weaken the cords, before the hand surgeon breaks it up through hand manipulation. However, this therapy is not yet available in Singapore. Surgery is an option reserved for more severe cases and does provide a more permanent solution to this condition. Surgery requires the careful removal of the fibrous cord tissue, and the tissues excised are sent for histology. However, recurrence is still possible.
Dupuytren’s contracture is not life-threatening, but it is recommended for you to consult a hand surgeon to determine the treatment method that is most suitable for you. Reach out to us today if you are suffering from Dupuytren’s contracture, and let us help you.
