Dupuytren's contracture (Palmar Fibromatosis) is a scarring of the fascia that covers the tendons and shortening of the palmar tendons, leading to flexion deformity and loss of the ability of the fingers to fully extend. Most often, the process affects the functions of the ring finger and / or little finger, but the disease can affect all fingers of the hand or fingers of both hands. At a young age, this disease is quite rare, but over the years, the incidence of Dupuytren's contracture increases. The incidence of Dupuytren's contracture in men is several times higher than in women. Dupuytren's contracture is most common in middle-aged men. If the disease occurs at a young age, then, as a rule, there is a rapid progression of symptoms and a more severe course of the disease.
Dupuytren's Contracture Treatment
Dupuytren's Contracture Treatment 


Dupuytren's contracture may initially present as a painless lump on the palm of the hand near the bases of the fingers. Usually, only a small part of the palmar aponeurosis on one hand undergoes cicatricial change. Without treatment the disease progresses. In most cases, severe symptoms appear only a few years after the onset of the disease. In men, Dupuytren's contracture tends to progress more rapidly than in women.


What Is The Cause Of Dupuytren's Contracture?

Scientists have not yet been able to determine the exact reasons for what causes Dupuytren's contracture, but it is believed that genetic factors play an important role in this. According to the study, people from Northern Europe are more affected by this.


What Are The Symptoms Of Dupuytren's Contracture?

Dupuytren's contracture does not occur suddenly, it develops gradually. That is, the tissue under the skin of your palms gradually thickens, during which it develops, the skin of your palms shrinks and dimples (pits) start appearing in it. Lumps of tissues are formed on the palms. These lumps can be sensitive to touch, but they do not cause pain.

In the later stage, the tissue cords formed under the skin of the palms reach the fingers and as soon as this cord starts tightening, the fingers start turning towards the palms, sometimes it can be serious. Usually, the last two fingers away from the thumb are affected by this. In rare cases it affects the thumb and forefinger. Dupuytren's contracture usually occurs in one hand, but in some cases it can affect both hands.


Risks Associated With Dupuytren's Contracture

The cause of Dupuytren's contracture is not known, but there are some risk factors that increase its chances:
  • It usually occurs in people over the age of 50.
  • Men are more likely to have Dupuytren's contracture than women.
  • People in northern Europe are at higher risk of Dupuytren's contracture.
  • People who have had Dupuytren's contracture before in their family are at higher risk.
  • Tobacco and alcohol use can also increase the risk of Dupuytren's contracture.
  • Diabetes patients also have a higher risk of this.


Dupuytren's Contracture Diagnostics

The diagnosis is made by an orthopedic traumatologist on the basis of complaints, information about the duration of the disease, and the impact of the presence of contracture on the quality of life. Most likely, the question will be asked about smoking, about drinking alcohol, about the presence of cases of Dupuytren's contracture in the next of kin. The hand is also examined, palpation, the study of the mobility of the fingers. On palpation of the hand area, the doctor can determine the thickening of the palmar fascia in the form of dense strands or nodules. In the initial stages of the disease, such nodules are found, as a rule, in the palm of the hand. In later stages of the disease, connective tissue nodules may be located in the area of ​​the fingers. The amplitude of flexion and extension of the fingers is assessed. In the presence of Dupuytren's contracture, extension of one or more fingers can be difficult. In advanced cases, movement in the joints of the fingers affected by the process is impossible. In most cases, additional laboratory and instrumental research methods are not required to make a diagnosis.

Dupuytren's Contracture Treatment
Dupuytren's Contracture Treatment 



Stages of Development of Dupuytren's Contracture


1st Degree:

Is manifested by the presence of subcutaneous compaction in the palm of the hand, which practically does not limit the extension of the fingers and does not interfere with the patient in everyday life. At this stage of the development of the disease, there is no significant impairment of the functions of the hand, and surgical treatment, as a rule, is not carried out.


2nd Degree: 

limitation of passive extension of the finger to 300. A relatively small limitation of the function of the hand is also often not a reason for surgery in the eyes of patients. However, with a radical aponeurectomy at this stage, the extension of the fingers can be fully restored.


3rd Degree:

finger extension deficiency ranges from 300 to 900. Due to the high prevalence of the process, surgical treatment sometimes presents significant difficulties. Straightening the finger to full extension often requires a volar capsulotomy. During the operation, sometimes there is a deficiency of the skin, excessive tension of the neurovascular bundles of the fingers. Surgical treatment at this stage does not always lead to complete restoration of finger extension.


4th Grade :

Is characterized by the involvement of the tendon apparatus and articular structures in the pathological process, and the deficit of extension of the finger exceeds 900. Surgical treatment has limited effectiveness and often involves such radical operations as corrective arthrodesis of the finger joints.

Treatment of contracture can be carried out both conservatively and surgically. The main reason for choosing a method of treatment is the severity of pathological changes. Dupuytren's contracture is treated by an orthopedic trauma surgeon.


Which Finger Does Dupuytren Contracture Affect

The middle finger can also be impacted, but the two fingers furthest from the thumb are most frequently affected. Thumb and index fingers are rarely impacted. Both hands can develop Dupuytren's contracture, but usually only one hand is more severely affected.


Can You Live With Dupuytren's

People who have Dupuytren's disease frequently downplay its early symptoms and gradually and unconsciously adjust to it. When people suddenly have trouble finishing tasks, it comes as a surprise to them that they have the condition.


Dupuytren's Contracture Treatment

Conservative treatment at an early stage of Dupuytren's contracture.
  • Massage.
  • Therapeutic Exercises Aimed At Stretching The Palmar Fascia.
  • Physiotherapy.
  • Position Correction With A Splint Or Plaster Cast (Fixing The Fingers In The Extension Position). As A Rule, Longet Bandages Are Used During Sleep.
  • Warm Baths.
  • Corticosteroid Injections (For Local Inflammation).
Conducting conservative therapy can slow down the progression of the disease, increase the degree of mobility of the fingers, but sooner or later the question arises of the need for a surgical operation. If the operation is performed on a young patient for severe contracture, then after a few years or decades there may be a relapse of the disease, which will require a second operation.

Dupuytren's Contracture Treatment


Surgery

As a rule, surgery can be recommended by an orthopedic trauma surgeon if the angle of finger flexion reaches 30 degrees. If the operation is performed on a young patient for severe contracture, then after a few years or decades there may be a relapse of the disease, which will require a second operation. The goal of the operation in most cases is the partial or almost complete excision of the palmar fascia and fibrous bands that connect the fascia to other tissues of the hand. As a result of such an operation, most patients have a positive effect, the movements of the fingers are restored in full.

Aponeurectomy is the most common radical treatment , the technique of which is quite complex. The surgeon must have an accurate understanding of the problems that arise during the operation and the best ways to solve them. The main principles of aponeurectomy are:
  • Correct Choice Of Surgical Approach;
  • Radical Removal Of Pathologically Altered Tissues;
  • Prevention Of Damage To The Nerves Of The Hand;
  • Maintaining Sufficient Blood Supply To The Fingers;
  • Plasticity Of Emerging Skin Defects;
  • Prevention Of Circulatory Disorders Of The Formed Skin Flaps;
  • Prevention Of Hematoma Formation;
  • The Best Way To Close A Wound.
The operation is performed under local or general anesthesia. The palm is preliminarily prepared with the use of enzyme preparations and physiotherapy, since otherwise it will be difficult to separate the skin and the scar bands located under it during the operation.

With a correctly performed operation and preoperative preparation of the skin, there is often no need for excision of the skin and the use of free skin grafting. However, in itself, a well-performed operation does not give reason to hope for a good outcome. The best positive result is achieved only with consistent preoperative preparation, surgery and postoperative recovery complex.

In rehabilitation after surgery, previously functional treatment, dosed movements, massage and thermal physiotherapy and electrotherapy are used. Restoration of lost hand functions after surgery and rehabilitation ensures the return of a full quality of life.


What Happens If You Don't Treat Dupuytren's Contracture

The fascia is made up of cord-like strands of fiber that extend from the palm up into the fingers. If Dupuytren's contracture is left untreated, the tissue tightening will cause the fingers to become bent downward permanently.


Dupuytren's Contracture Exercises

Exercises for the hands won't stop Dupuytren's or stop it from progressing. However, if you have a mild or early stage of the disease, they might be beneficial. After surgery, which is the recommended course of treatment for advanced Dupuytren's, hand exercises are typically of utmost importance. Consult your doctor or physical therapist to determine whether and how hand exercises can benefit your particular situation because every person is different.

Spreads Of Fingers

Although all of your fingers may be affected, the ring and pinky fingers are most frequently affected by Dupuytren's contracture. Placing your hand flat on a table and practicing spreading all of your fingers as far apart as you can and then bringing them back together is a common finger flexibility exercise.


Finger Lifts

In order to perform this exercise, lay your hand flat on a table and focus on one finger at a time. Each finger should be raised off the surface and held there for a short while. Do not attempt to forcefully stretch or extend your fingers if they are too stiff or curled to do this exercise. This may result in your contracture worse.


Exercises For The Grip

You can practice picking up objects with your hand to maintain dexterity and improve your grip. It will be simpler to start with larger objects and work your way down to smaller ones. Making a small ball out of a piece of paper or a small towel is another way to experiment with improving your grip.


Exercise For The Thumb

Make a "O" with your thumb by bringing the tips of each finger one at a time, to work out your thumb. Holding your hand out flat in front of you with your fingers grouped together is an additional exercise. Spread out your thumb so that it is separated from the other fingers, then try to touch the base of your pinky finger with it before bringing your hand back to the spread position.


Lifestyle Changes and Home Remedies

If you have mild or early stages of Dupuytren's contracture, you can use these methods to protect your hands:
  • Don't Hold The Tool Too Tightly
  • Use Gloves With Heavy Padding When You Need To Hold On To Something Sturdy

For More Details You Can Contact Doctor.