What is Dupuytren’s Contracture?
Dupuytren’s disease (often called Dupuytren’s contracture) is a thickening of the fibrous tissue underneath the skin of the palm and fingers. Dupuytren’s is not actually a disease, but rather a disorder; it is characterized by a benign (non-cancerous) proliferation of cells in the hand. This proliferation of tissue can lead to a contracture, which is the shortening and hardening of soft tissue causing deformity and rigidity in the hand. This contracture and proliferation starts in the palmar fascia, a fibrous band of connective tissue that runs along the palm. The tissue affected by Dupuytren’s is disproportionately made up of type III collagen, which is the collagen present in wound healing. It also has contractile properties, which is what leads to the contractures that characterize the disease. Dupuytren’s is inherited, occurring mostly in Caucasians of northern European descent; for this reason, it is sometimes called the “Viking Disease.”
Symptoms & Causes
Dupuytren’s usually starts with a painless bump in the palm of the hand. Often, those affected notice a small lump or a “pucker” of the skin in the palm. Over time, these lumps may grow or proliferate causing a contracture of the surrounding soft tissue. Dupuytren’s does not hurt unless you try to stretch out the contracture. As the contracture worsens, patients often complain of an inability to place their hand in certain positions, like flat on a table.
Anyone can get Dupuytren’s disease, but there is a very strong genetic basis for the condition. The most common patient with Dupuytren’s is a white male in their sixth decade of life. However, it can occur as early as the third decade of life and is also found in women, albeit far less often. When presenting young, Dupuytren’s tends to be very aggressive.
For many patients with Dupuytren’s, intervention is not necessary. A painless bump or a ‘cord’ does not need intervention if it has not led to a contracture. The primary indications for intervention are a contracture equal to or greater than 40° of the metacarpophalangeal joint (knuckle) or any contracture of the proximal interphalangeal joint (the first joint of the finger). If intervention is necessary, the two primary treatment options are surgery or an enzyme injection called Xiaflex. Given its genetic basis, nothing will ‘cure’ a patient of Dupuytren’s. Your physician will decide which type of treatment is best for you based on the location and severity of the contracture being treated.
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