What is Dupuytren’s Disease?
Dupuytren’s (du-pwe-TRANZ) Contracture (sometimes also called Dupuytren’s Disease, palmar fibromatosis or morbus Dupuytren) causes fixed flexion contractures of the hand, where fingers may fully flex into the palm, but cannot be fully extended (straightened).
The condition is named after Baron Guillaume Dupuytren, the surgeon who first described the surgical correction of this condition.
The condition is caused by an abnormal thickening of the connective tissue just beneath the skin known as fascia (or palmar aponeurosis). This thickening occurs in the palm and can extend into the fingers (see Figure 1). Firm cords and lumps may develop that can cause the fingers to bend into the palm (see Figure 2).
The skin may become involved in the process but the deeper structures (such as the tendons) are not directly involved. Occasionally, the disease will cause thickening on top of the finger knuckles (knuckle pads), or nodules or cords within the soles of the feet (plantar fibromatosis).
What causes Dupuytren’s Disease?
While the exact cause of Dupuytren’s Disease remains unknown, it is thought to be associated with certain biochemical factors within the involved fascia. It has very specific associations, which include:
- Scandinavian or Northern European ancestry (it has been called the “Viking disease), but also seen in some Mediterranean countries (e.g. Spain and Bosnia) and in Japan.
- Men rather than women (men are ten times as likely to develop the condition)
- Age over 40 years
- Family history (60 to 70% of those afflicted have a genetic predisposition to Dupuytren’s Contracture)
- Liver cirrhosis
Although unproven, Dupuytren’s Contracture has also been suggested to be associated with trauma, diabetes, alcoholism, tobacco use, liver disease and phenytoin treatments for epilepsy. While there is no conclusive evidence that hand injuries or specific occupational activities have a higher risk of developing Dupuytren’s disease, it has been suggested that the condition may be caused, or triggered by physical trauma such as manual labor or over-exertion with the hands. It is however interesting to note, that the condition does not always occur in the dominant hand, and has no correlation with right- or left-handedness.
What are the symptoms and signs of Dupuytren’s Disease?
In Dupuytren’s Disease, the tough connective tissue within one’s hand becomes abnormally thick, which can cause the fingers to viagra and can result in impaired function of the fingers. The little and ring fingers are most commonly involved. In many cases, both hands are affected, although the extent of involvement may be different.
Symptoms of Dupuytren’s Disease include the development of bands, cords, lumps and pits within the palm. Progression is unpredictable. Some individuals will have only small lumps or cords while others will develop severely bent fingers. Those with more severe disease may begin to experience symptoms at an earlier age.
The condition usually has a gradual onset and often beginning as a tender lump in the palm. This discomfort usually resolves, and Dupuytren’s Disease is not typically painful. Over time, tough bands of tissue may develop, which are visible on the surface of the palm and may appear similar to a small callus. The lumps or nodules are become firm and adherent to the skin.
As the fascial bands thicken, they form cords which extending from the palm into one or more fingers, and as these cause tethering and bending or contractures of the fingers. These are the source of the reduced mobility commonly associated with the condition. These cords may be sometimes be mistaken for tendons, but actually lie between the skin and the tendons. The disease may first be noticed because of difficulty placing the hand flat on an even surface, such as a tabletop (see Figure 3).
Contractures generally progress slowly, especially in women. However, in severe disease, the condition progresses more rapidly, affects both hands and may have associated foot involvement. As the contractures worsen, individuals begin to experience increasing difficulty with daily activities such as shaking hands, washing up, wearing gloves and putting their hands into pockets
To find out more about treatments for Dupuytren’s Contracture, read our next post (Part 2).