Facts and Tips for Dupuytren's Contracture
Dupuytren's Contracture Treatment Basics
Named after the French surgeon who first described it in 1834, Dupuytren's (pronounced DOO-pa-trens) contracture is a progressive hand condition that causes thickening of the palmar fascia, the tissue under the palm. As this tissue thickens and contracts, your fingers may start curling into the palm of your hand. "Dupuytren's contracture may cause painful nodules in the palm of the hand or painless thick bands that may eventually make it impossible to extend the fingers," says Peter J. Evans, MD, PhD, an orthopedic surgeon and director of the Upper Extremity Center at the Cleveland Clinic in Ohio. Although Dupuytren's contracture tends to progress slowly over years, you shouldn't ignore its signs and symptoms. Find out more about the condition.
FACT: Dupuytren's Contracture Is Hereditary
Dupuytren's contracture can be passed down through families and is most common in people who have ancestors from Scandinavia and other areas in northern Europe. According to the British Dupuytren's Society, this hand deformity can affect up to 20 percent of men older than 60 and 20 percent of women older than 80 in the United Kingdom. A 2011 Internet survey to see how many Americans have Dupuytren's found that just 1 percent of responders had been diagnosed with the disorder, and 7 percent had symptoms of Dupuytren's contracture but had never been diagnosed. Of those diagnosed, 18 percent reported a close family member who had symptoms of Dupuytren's.
TIP: Know The Risk Factors
Family history isn't the only risk factor for Dupuytren's. Others include having diabetes, being male, being older, smoking, drinking alcohol, and taking certain medications for seizures, most commonly phenobarbital. You're also at higher risk for Dupuytren's contracture if you've experienced contracture in other parts of your body, such as your penis or your feet. Knowing if you're at higher risk for Dupuytren's contracture may make you more aware of early signs and symptoms like tender nodules or thickened bands in your palm of your hand. "Early in the condition, tender nodules in the palm may make gripping painful," Dr. Evans says.
FACT: The Last Two Fingers Are Most Often Affected
Dupuytren's contracture usually strikes the ring and pinky fingers, but any finger can be involved. The condition may affect both hands, although one is usually worse than the other. As Dupuytren's contracture progresses, it can become harder to use your hands, and you may start to feel clumsy and unsafe. Although Dupuytren's usually isn't painful, simple tasks like washing dishes, buttoning clothing, shaking hands, putting on gloves, or using pockets may become difficult to do.
TIP: Seek Dupuytren's Contracture Treatment Promptly
All treatments for Dupuytren's contracture work better before severe contraction sets in. "Some people wait too long to see a doctor because they can get by with a partial grip for a long time," Evans says. It's important to monitor Dupuytren's contracture closely and start treatment as soon as problems surface. Once you progress to full Dupuytren's contracture, you have fewer options to correct the hand deformity.
FACT: Dupuytren's Can Be Unpredictable
The course of Dupuytren's isn't the same for everyone. Some people never develop complete contracture and don't need treatment. If Dupuytren's contracture treatment is needed, however, there are several options available ranging from simple office procedures to complex open surgery. "Reasons for treatment are if nodules are causing pain or if fingers have started to curl into the palm," Evans says.
TIP: Don't Treat Dupuytren's Contracture On Your Own
Once you have Dupuytren's, there's nothing you can do on your own to stop it. "Trying to force fingers open with splinting or stretching can cause trauma that may make the condition worse," Evans says. "You can try hand massage or heat if it helps with discomfort, but it won't change the course of Dupuytren's." Hand exercises may be used as part of physical therapy after Dupuytren's contracture treatment to strengthen your hand and help it heal properly.
FACT: Your Doctor Can Help With Relief
In-office procedures that your doctor can use to treat Dupuytren's include needle aponeurotomy, steroid injections, and enzyme injections. In the case of needle aponeurotomy, a long needle is inserted through the skin of the palm to soften and break up the bands of tissue that are contracting the fingers. "This procedure has an easy recovery but a high recurrence rate," Evans says. "Afterwards, the fingers can often be manipulated back into place. You can feel the bands giving way as the fingers are released."
FACT: In Advanced Cases, Surgery May Be Needed
"Open surgery may be done to cut the bands of thickened tissue in the hand," Evans says. In severe cases of Dupuytren's contracture, it may be necessary to remove as much of the affected palmar fascia as possible. This type of surgery can be compared to weeding a garden: "The weeds tend to come back, especially if you don't get them all out," he says. In addition, the surgery is extensive and may require a skin graft to close the palm.
TIP: Ensure A Good Recovery
Although hand splinting and stretching exercises aren't helpful before surgery for Dupuytren's contracture, they're important after this type of treatment. Work closely with your doctor to lessen the chances that the condition will return. This may include six weeks of physical therapy with hand massage and stretching exercises. You may also need to wear a hand splint at night for up to six months after surgery. Follow all of your doctor's orders for the best recovery possible.
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