Dupuytren's Contracture, or When the Fingers Remain Forcibly Bent

Information

What is Dupuytren's contracture?

In this condition, the fingers cannot be straightened and remain forcibly bent. The cause is the affected connective tissue network in the area of the palm. It thickens, shortens, and in this way bends the finger. The collagen making up this network, called the palmar aponeurosis, undergoes changes due to the proliferation of the cells that produce it. The tendons and the rest of the finger's motor apparatus are unaffected at the outset, and are later damaged secondarily due to the immobilization. The condition is also known as Dupuytren's disease, Dupuytren's contracture, palmar fibromatosis, and "Viking disease." The thickening can also affect other areas where structures of a similar type are present - the soles of the feet, the penis, the shoulder, the upper side of the fingers, and even the area of the outer ear. It most often affects the 4th and 5th fingers of the hand.

What are the causes of the disease and the risk factors?

The condition is genetic and hereditary in nature. It occurs more often among people of the white race. It is also widespread in Bulgaria. Dupuytren's contracture affects men of mature and more advanced age. It is not of tumorous nature. Risk factors include alcoholism, diabetes mellitus, and epilepsy. There is no relationship between the patient's physical activity and the development of the disease.

How does the disease progress?

Gradually. It begins with the formation of a small nodule in the palm or at the base of the finger, which is most often painless. Gradually, the nodule turns into a very dense cord, which extends along the length of the finger and bends it, and this progression can continue for many years. A rare complication of Dupuytren's contracture can occur after a hand injury or surgical intervention on the palm. This leads to a faster and more significant bending of the fingers.

Is there pain?

The condition is not characterized by pain, but in advanced stages it substantially limits work capacity and self-care. The fingers are bent, drawn close to one another, and the skin is also affected. There are milder and more severe stages of the disease - ranging from a small nodule in the palm to permanently bent, immobile fingers.

How is it diagnosed?

The diagnosis is not difficult, but in the earliest stages there is potential for diagnostic errors. My advice is for patients to consult a hand surgery specialist, since they are the most familiar with the many particularities of the disease at its various stages. Patients should be given a thorough explanation of the nature of the disease, when the surgery should be performed, and what improvement can be expected.

Is there treatment, and what does it involve?

Non-surgical methods exist - medication-based, physical therapy, or injecting various products into the affected areas. These practices are applicable mainly in the earliest stages and are not common in Bulgaria. Waiting leads to severe joint damage and further complicates the condition.

The most effective method of treatment is surgery. Surgical treatment consists of correcting the deformity of the fingers and restoring the function of the hand. Using a surgical technique appropriately chosen according to the stage of the disease, the surgeon removes the affected tissue and thereby frees up movement in the joints of the finger. The surgery is delicate and should be performed by a proven specialist.