What is Dupuytren’s Contracture?

Dupuytren’s Contracture, also known as palmar fibromatosis, is a disorder that affects either one hand or both in the palm and last two fingers. It generally only affects one hand, but can affect both simultaneously. It results from the tightening and thickening of a layer of connective tissue located under the skin and above the musculature in the palm, called the palmar fascia or palmar aponeurosis. The palmar fascia’s function is mechanical in nature. It keeps the skin of the palm securely attached and helps to provide a stronger grip and protection of the underlying tendons. Think of the skin on your back and how moveable it is, now compare that to the skin on your palm. It doesn’t move much. This is because of the palmar fascia. It is fibrous in structure and very thick and strong. As some strands of the palmar fascia extend into the last fingers, a contracture can also affect a shortening, or permanent flexing of the last two fingers along with the palm of the hand. Dupuytren’s Contracture presents as an inability to fully extend (straighten out) the fingers and hand.

Dupuytren’s contracture progresses quite slowly in an individual so it is imperative to seek treatment as soon as you notice the signs and symptoms of it. If left untreated, it can lead to a very painful condition of the hand that severely limits function.

What Causes Dupuytren’s Contracture?

There is no known cause of palmar fibromatosis. There are risk factors that make an individual more susceptible to this condition. These are:

● Excessive alcohol use
● Certain diseases such as Diabetes and other endocrine disorders
● Epilepsy
● Genetics
● Age

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What are Symptoms of Dupuytren’s Contracture?

The symptoms to be aware of if you suspect this condition are:

● Loss of function of the fingers and a visible physical deformity of the hand consisting of a permanently contracted palm, and ring and pinky finger with the loss of ability to straighten the fingers
● Nodular growths on the fingers
● Development of cords that you will be able to feel under your skin

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Treatment for Dupuytren’s Contracture

Treatments for this condition will depend on the severity to which it has progressed. No treatment may be needed if the condition is not causing you pain and dysfunction. The goal in this case would be to prevent the disorder from further progressing which will involve stretching exercises of the hand and keeping it as mobile as possible.
In the case that treatment is necessary, there are several options. These are:

● Corticosteroid injections
● Pain medications
● Splinting
● Dry Needling (a new procedure performed by a physical therapist that involves inserting a small needle into your palmar fascia and break up the connective tissue causing problems)
● Enzyme injection

In severe, advanced cases where Dupuytren’s Contracture is causing significant pain and dysfunction, surgical intervention is an option. One procedure, known as a Fasciotomy, consists of an incision to the palm and diving of the cords formed.

Another procedure known as a subtotal palmar fasciectomy, consists of a removal of the cords and any other problematic connective tissue.
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