Although the cause of Dupuytren`s contracture is unknown, it is believed that changes in one or more genes affect the risk of developing this disorder. Some of the genes associated with the disease are involved in a biological process called the Wnt signaling pathway. This pathway promotes the growth and division (proliferation) of cells and is involved in determining the specialized functions of a cell (differentiation). 8. Hu FZ, Nystrom A, Ahmed A, Palmquist M, Dopico R, Mossberg I, et al. Mapping of an autosomal dominant gene for Dupuytren contracture on chromosome 16q in a Swedish family. Clin Genet 2005;68:424–9. The disease usually develops slowly over a period of several years, according to AAOS, and while some people with Dupuytren`s contracture may have only the bumps under the skin, most experience worsening symptoms that can lead to impaired finger function and mobility without treatment. “After all, patients have a hard time stretching their fingers,” says Daniel Osei, MD, an orthopedic hand and upper limb surgeon at the Hospital for Special Surgery in New York City. Dupuytren`s contracture is usually passed down from generation to generation in families and is the most common inherited connective tissue disease. The inheritance model is often unclear.
Some people who inherit genetic changes associated with Dupuytren`s contracture never develop the disease. Your doctor can usually determine if you have Dupuytren by feeling the thickened scar tissue and seeing if your fingers are pulling inward. You can also take a “table” test, where you place your hand on a table with your palm down to see if it`s flat. If this is not the case, you may have a contracture that may require surgery. Your doctor may also test your grip and range of motion in your fingers. In men, Dupuytren`s contracture most often occurs after the age of 50. In women, it tends to occur later and be less severe. However, Dupuytren`s contracture can occur at any time in life, including childhood. The disorder can make it more difficult, if not impossible, for those affected to perform manual tasks such as preparing food, writing or playing musical instruments. Other risk factors for developing Dupuytren`s contracture may include smoking; extreme alcohol consumption; liver disease; diabetes; high cholesterol; thyroid problems; certain medications, such as those used to treat epilepsy (anticonvulsants) and previous injuries to the hand. Dupuytren contracture occurs when 1 or more finger leans towards your palm. There is no cure, but your fingers can be stretched if they are heavy.
Degrees of Dupuytren`s disease. Grade 1 presents as a thickened nodule and ligament in the palmar fascia that can progress to skin binding, fold or sting. Grade 2 presents as a peritendinous ligament that limits the expansion of the affected finger. Grade 3 is presented as a bending contracture. Dupuytren contracture occurs when the tissue under the skin near your fingers becomes thicker and less flexible. Dupuytren contracture (du-pwe-TRANZ) is a condition that gradually causes the connective tissue (fascia) to thicken under the skin of your palm and becomes frightening. Although Dupuytren is not always painful, it restricts movement. The thickened fabric forces several fingers – usually your ring and little fingers – to roll towards your palm. The curvature caused by the thick tissue is called contracture. Finding and comparing hospitals for Dupuytren`s contracture Although reports of Dupuytren`s contracture first appeared in the medical literature in the 1600s, doctors still don`t know what causes scar tissue to form. The disease tends to work in families, so genes may be involved.
Dupuytren is more common in middle age, especially in men of Northern European descent. Alcohol and tobacco use, diabetes and epilepsy also increase the risk. Dupuytren`s contracture is thought to be familial (hereditary). The exact cause is not known. The symptoms of Dupuytren`s contracture may resemble other health problems. Always contact your doctor for a diagnosis. Surgery should be performed in patients with Dupuytren`s disease when the metacarpophalangeal joint contracture exceeds 40 degrees or when the proximal interphalangeal joint contracture exceeds 20 degrees. Dupuytren`s disease is a progressive disease that causes the fibrous tissue of the palmar fascia to shorten and thicken. The disease is common in men over 40 years of age; in the case of persons of Northern European origin; and in people who smoke, drink or have diabetes. Patients have a small pitted mass (or nodules) on the palm of the hand, which progresses slowly to the contracture of the fingers. The disease can first be treated by observation and non-surgical treatment.
It will regress without treatment in about 10% of patients. Injecting steroids into the nodes has been shown to reduce the need for surgery. Surgical referral should be made when the metacarpophalangeal joint contracture reaches 30 degrees or when proximal interphalangeal joint contracture occurs to any degree. The timing of surgery varies, but surgery is usually performed when the metacarpophalangeal joint contracture exceeds 40 degrees or when the proximal interphalangeal joint contracture exceeds 20 degrees. Percutaneous needle aponevotomy in the office is an alternative to surgery. If contractures are present, the angles on the MCP and proximal interphalangeal joints (PIP) should be noted. Functional history and a rate of progression should also be taken into account.1 The hueston table test can help with diagnosis. If a patient is unable to place their palm on a table, the test is positive.
Disease progression is classified using a grading system (Figure 1). Grade 1 disease presents as a thickened node and ligament in the palmar fascia; This adhesive tape can pass to the attachment of the skin, wrinkles or bites. Grade 2 presents as a peritendinous ligament and the expansion of the affected finger is limited. Grade 3 presents as an F-lexion contracture.2 Grade 1 disease can be treated expectantly at first, but injecting a steroid at the node (Table 1 and Figure 2) may be helpful. Surgery is recommended if function is impaired, contracture progresses, or severe deformity is hindered. Referral to a hand surgeon is indicated when the MCP joint contracture reaches 30 degrees or when the PIP joint contracture occurs to any degree.2 The hueston table test is a good indication for referral. The timing of surgery varies, but surgery is usually performed when the MCP joint contracture exceeds 40 degrees or when the PIP joint contracture exceeds 20 degrees.2,3,12 In addition, the diagnosis of Dupuytren`s contracture can help you be aware of the conditions involved. For example, people with dupuytren are at a higher risk of developing other connective tissue diseases, including penis pads (nodules in the ankles), ledosis disease (nodules in the soles of the feet), frozen shoulder (scar tissue and loss of fluid in the shoulder joint) or Peyronie`s disease (development of scar tissue in the penis), according to the U.S. National Library of Medicine. If you have any of these symptoms, it is important that you be examined early so that your doctor can confirm if you have Dupuytren and may rule out other conditions. These include the trigger finger, which is a problem with flexor tendons, where a finger can get stuck in a bent position, and rheumatoid arthritis, which can cause a buttonhole or deformation of the neck of the fingers, according to the American Society for Surgery of the Hand). If the symptoms of contracture are severe enough to interfere with daily life, surgery may help.
During the procedure, your surgeon removes the thickened tissue from your palm, allowing the fingers to move again. Surgery can usually restore you to normal exercise, but risks may include infections and nerve damage. Dupuytren`s disease can be distinguished from other causes of hand contracture, as it begins with a bump and progresses slowly to the contracture of the fingers. During the physical examination, doctors should pay attention to the site of the node and the presence of contractures; Bands; and the consumption of skin holes, tenderness and the formation of dimples. .