(Dupuytren's Disease)
Dupuytren's contracture causes one or more fingers to bend into the palm. The cause is not known. In some cases it remains mild and does not require treatment. If the function of the hand becomes affected then a surgeon may recommend an operation to cut through the thickened tissue causing the contracture, or to cut it out.
What is Dupuytren's contracture?
Dupuytren's contracture, sometimes called Dupuytren's disease, is a condition of the hands and fingers. If you develop Dupuytren's contracture the affected fingers bend (contract) towards the palm and you cannot straighten them fully. Typically, the ring finger is usually affected first. Then the little finger, and then the middle finger. It takes months or years for the condition to develop.
Dupuytren's contracture is not usually painful. The main problem is that you cannot use the affected fingers properly. The extent of the contracture varies greatly from mild to severe. Sometimes just one hand is affected, and sometimes it affects both hands.
What causes Dupuytren's contracture?
The tissue called the 'connective tissue' in the affected fingers and palm becomes thick and abnormal. This is the tissue just under the skin and above the tendons. This forms into bands of thick tissue which pulls the fingers towards the palm.
The reason why this tissue becomes thickened is not known. There seems to be a genetic factor as it has a tendency to run in some families. It is more common in people with cirrhosis of the liver, diabetes, epilepsy, and alcohol dependence. In some cases it is thought that an injury to the hand may trigger the condition to start in someone who is genetically prone to develop the condition.
However, in most people there is no known cause or associated illness or inury. It is not due to your type of job, vibrating tools, manual work, or other working environments.
Who gets Dupuytren's contracture?
Dupuytren's contracture was first described by Baron Dupuytren in 1831. He originally thought it was due to many years of holding on to the reins of a horse! This is obviously not the case as it remains a common condition. It is a disease of later life. Most cases occur in middle aged or older people, but it sometimes develops in younger adults. It is more common in men than women, and most commonly found in people of European descent. About 1 in 6 men in the UK over the age of 65 have some degree of Dupuytren's contracture.
What are the treatments for Dupuytren's contracture??
No treatment may be an option
In mild cases no treatment may be needed. In many cases the condition remains mild and causes little interference with use of the hand. Treatment is needed only if the normal function of the hand is affected. As a general rule, if the contracture is 30 degrees or more, then a surgeon may recommend a surgical procedure to straighten out the affected finger or fingers.
(Non-surgical treatments have been tried. For example, ultrasound therapy, vitamin E cream, various medicines, etc. However, non of these seems to have any effect. The only effective treatment to release the contracture is a surgical procedure.)
Surgical procedures
There are three main options:
Open fasciotomy. Fasciotomy simply means cutting the thickened tissue. (Another word for the thickened tissue is called fascia.) Open fasciotomy means that to get to the thickened tissue, the overlying skin is cut open. This allows the surgeon to see the thickened tissue, and then to cut it. The skin is then stitched back together. It is a relatively minor procedure which can be done under local anaesthetic as a 'day case'.
Needle fasciotomy. This is sometimes called needle aponeurotomy. What happens is that the surgeon pushes a fine needle through the skin over the contracture. He or she then uses the sharp bevel of the needle to cut the thickened tissue under the skin. In effect the needle acts like a 'saw' as the surgeon moves the needle too and fro to 'saw' through the thickened tissue. The procedure is done under local anaesthetic and can be done in an outpatient clinic.
Open fasciectomy. This means removing the abnormal thickened tissue. This is a more extensive hand operation.
So which is the best option? It is best to talk it through with your surgeon. There are pros and cons of each procedure. For example:
- Needle fasciotomy can be a quick procedure and is becoming more popular. Many people prefer this procedure as the hand can be used more or less straight away after the procedure. However, the contracture returns in about half of cases within 3-5 years following this procedure. But, if it does return, the procedure can be repeated. Needle fasciotomy may not be appropriate for severe Dupuytren's contracture.
- If you have an open fasciectomy, (removal of the thickened tissue), the chance of the problem returning is much less than with a fasciotomy (where the tissue is just cut through). However, it is a more extensive operation and it can take some time for the wound to heal and for you to get full function of the hand.
- All the procedures described above are usually successful. But remember, all operations carry a risk. There is a small risk of damage to nearby tendons and nerves during these procedures, and of infection developing in the hand.
A final note of caution
Whatever the procedure you opt for, make sure the person doing the operation is a fully trained and experienced in the procedure. Needle fasciotomy sounds an easy procedure, but it actually needs to be done by someone who has detailed knowledge of the delicate anatomy of the hand. The fine needle 'saws' through the thickened tissue. However, the operator cannot see the end of the needle and an inexperienced operator may also 'saw' through nerves, tendons and blood vessels. One concern of properly trained hand surgeons is that needle fasciotomy is offered by some poorly trained operators in dodgy 'private clinics'. Just beware of this.
©EMIS and PIP 2006 Updated: October 2006
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