A fibrous layer of tissue called fascia under the skin thickens abnormally – and tightens over time It occurs in the palm of the hand at the base of the fingers. The condition is known as Dupuytren’s disease or Dupuytren’s contracture. The thick tissue area under the skin (fascia) may develop into a thick band or a hard lump. When this happens, one or more fingers contract or curl or pulled in towards the palm or pull sideways. Little fingers or the ring finger are mostly affected. In a majority of cases, Dupuytren’s disease affects both hands. In rare cases, feet may also be affected.
Dupuytren’s Contracture Symptoms
Small nodules or lumps may form in the palm. They are typically fixed to the overlying skin. Nodules initially feel tender but gradually lose tenderness over time. There is a deep indentation of skin or pitting of the skin near the nodules.
Causes of Dupuytren’s Contracture
The causes of this condition are mostly unknown (idiopathic), but the risk increases in the following cases:
- A history of diabetes or epilepsy
- Excessive Alcohol Consumption
- A strong family history of the condition
It is still unknown whether one can prevent Dupuytren’s disease or stop it from coming back.
Dupuytren’s Contracture Diagnosis
Your orthopedic doctors will test the feeling in your fingers, thumb, and palm. He or she will also test the pinch and grip strength. The doctor will also record the location of bands and nodules on the palm. He or she uses a special instrument to measure the contracting and curling ability of your fingers. The doctor will also measure the range of motion in the fingers. Based on the findings and observations, the doctor will make a diagnosis. In general, treatment depends on the seriousness of the condition, previous history, overall health, and age of the patient.
In a majority of cases, the condition progresses very slowly. And therefore, remains mild for up to several years. If the symptoms remain mild, no treatment is needed. In moderate to severe cases, moving and straightening the affected fingers may become difficult. Therefore, people who develop these symptoms may need treatment to reduce the contracture and improve motion. In a worse or more complex situation or in more severe cases, treatment is less likely to result in complete correction and recovery.
Fasciectomy: An Orthopedic surgeon performs this surgery to straighten the fingers. The surgeon makes a cut along the palm and fingers to straighten them. Your surgeon performs the procedure under general or local anesthesia. You can leave the hospital on the same day and the recovery time of around one to two months.
Needle Fasciotomy: Your doctor performs this procedure by inserting needles in several places along your palm and fingers to straighten and loosen them. A local anesthetic is used to numb the hand. You can leave the hospital on the same day. The recovery time is around two weeks. With this procedure, the chances of recurrence of contracture are high compared to surgical procedures.
Dermafasciectomy: This procedure is similar to fasciectomy, but a skin graft is used here to replace the removed skin. The skin graft is taken from another area of the body. It is done under general or local anesthesia. In the first procedure, the abnormal skin is cut, opened, and removed to straighten the fingers. Three to four days later, the surgeon performs another procedure to add skin graft. The recovery time is a bit longer when compared to other procedures. However, contractures are less likely to come back.
Enzyme injection: This robust technique is a minimally invasive procedure. It is performed by a trained and expert orthopedic surgeon. First, the doctor numbs the thumb with a local anesthetic – and then injects the enzyme into the lump of tissue. The enzyme gradually dissolves tough tissues over several hours. This will help in letting the fingers straighten within a day.
When to see an orthopedic doctor?
When you are unable to use your hand for daily tasks, you should seek medical help. when you are not able to grasp large objects or straighten your fingers or when your symptoms are getting worse or when you develop new symptoms, you should seek an appointment with a specialist doctor.