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Dupuytren's contracture is a slow growing inflammatory thickening on the palm of the hand that eventually creates a deformity of the ring and little finger. It was first reported in the Lancet in 1831 by the French surgeon Guillaume Dupuytren. Although medical interventions may be required eventually, we describe here lifestyle and self help strategies which help relieve the discomfort especially in the early stages and help delay progression and deformity.
Early symptoms; Dupuytren's contracture usually begins as a fibrous thickening of the skin on the palm of your hand. As Dupuytren's contracture progresses, the skin on the palm of your hand may appear puckered or dimpled. A firm lump of tissue may form on your palm. This lump may be sensitive to the touch but usually isn't painful.
Later symptoms; In later stages of Dupuytren's contracture, cords of tissue form under the skin on your palm and may extend up to your fingers. As these cords tighten, your fingers may be pulled toward your palm, sometimes severely. Once this occurs, the fingers affected by Dupuytren's contracture can't be straightened completely, which can complicate everyday activities such as placing your hands in your pockets, putting on gloves or shaking hands. Only rarely are the thumb and index finger affected. Dupuytren's contracture can occur in both hands, though one hand is usually affected more severely than the other
The deformity is caused by fibrosis and thickening around the tendon sheaths of the hand which eventual contract. Why these form in the first place is unknown although it is known to be associated with:
Dupuytren's contracture most commonly affects the ring finger and little, and occurs most often in older men of Northern European descent. A number of treatments are available to slow the progression of Dupuytren's contracture and relieve symptoms
Lifestyle and self help strategies:
2. Massage / oils
3. Protect your hands:
4. Improve your general heath, particularly:
If the disease progresses slowly, causes no pain and has little impact on your ability to use your hands for everyday tasks, you may not need treatment. Instead, you may choose to wait and see if Dupuytren's contracture progresses.
Treatment involves removing or breaking apart the cords that are pulling your fingers in toward your palm. This can be done in several different ways. The choice of procedure depends on the severity of your symptoms and any other health problems you may have.
The main advantages of the needling technique are that there is no incision, it can be done on several fingers at the same time, and usually very little physical therapy is needed afterward. The main disadvantage is that it cannot be used in some locations in the finger, because it could damage a nerve.
In many ways, this is similar to the needling technique, except that the manipulation happens the next day, instead of during the injection procedure. The advantages and disadvantages of the enzyme injection are similar to needling, except that the enzyme injection may be more painful initially. Currently, enzyme injections can be used on only one joint at a time and treatments must be spaced at least a month apart.
The main advantage to surgery is that it results in a more complete joint release than that provided by the needle or enzyme methods. The main disadvantages are that physical therapy is usually needed after surgery, and the recovery time can be longer.
In some severe cases, surgeons remove all the tissue likely to be affected by Dupuytren's contracture, including the attached skin. In these cases a skin graft will be needed to cover the open wound. This surgery is the most invasive option and has the longest recovery time. People usually require months of intensive physical therapy afterward.