Dupuytren’s disease or Dupuytren’s contracture refers to a condition in which changes occur in the connective tissue of the hands. As the condition progresses, the fingers curve more and more toward the palm of the hand. As a consequence, those affected can no longer use their hands properly and experience a significant restriction in their everyday life.
What is Dupuytren’s disease?
By Dupuytren’s disease, physicians mean a pathological change in the connective tissue plate in the hand. In principle, healthy connective tissue has a rather fibrous structure at this point. However, the disease causes this to harden, and strands and nodules form which, on the one hand, harden the finger tendons and, on the other hand, reduce the size of the tissue plate of the hand. As a result, individual or even several fingers curl towards the palm and eventually can no longer be stretched. Pain does not usually occur with Dupuytren’s disease; however, the hands of those affected are clearly limited in motor function, especially in the later course of the disease. Often both hands are equally affected by the disease. Dupuytren’s disease usually occurs between the ages of 40 and 60, with men being affected more frequently than women. According to statistics, approximately 1.3 to 1.9 million in Germany suffer from Dupuytren’s disease.
Causes
The causes of Dupuytren’s disease have only recently become known. The fact that the condition occurs more frequently in some families has long suggested that a genetic predisposition may be crucial to the tissue change. Recent research has shown that the disease is caused by a gene mutation. The regions of the genes that are primarily affected are those that are responsible for cell signal transduction. If certain signaling pathways are disturbed, the connective tissue cells are transformed into a different type of cell, which is responsible, among other things, for wound healing and forms collagen. This is deposited on the flexor tendons of the fingers, causing permanent hardening. Dupuytren’s disease initially occurs gradually and in episodes, which makes it difficult to recognize the disease at an early stage. In the long term, however, there are significant restrictions in the movement of the fingers. Doctors divide the course of the disease into different stages. Finger extension can be affected between 0 and 135 degrees as the disease progresses.
Symptoms, complaints, and signs
Dupuytren’s disease is initially manifested by a nodular thickening at the base joint of the little or ring finger. Due to a proliferation of the connective tissue tendon plate on the palm of the hand, the affected fingers become increasingly retracted. Men suffer from this benign tumor significantly more often than women. This is not painful at first, at most unpleasant. And it makes it more difficult to stretch the fingers. As the disease progresses, it becomes increasingly difficult to open the fingers, as the tissue becomes increasingly shortened and hardened. In the palm, instead of nodules, already clearly thickened cords can be palpated. Indirectly affected joint capsules also shorten due to the lack of extension. Blood vessels as well as nerves are hindered in their function by the constant flexion of the fingers. In rare cases, pain may occur. These usually occur when a nerve is entrapped in one of the connective tissue nodules. If the contracture remains untreated over a long period of time, the affected fingers can retract until they rest against the palm and can no longer be extended. This leads to significant impairment in everyday activities, as the hand can no longer perform its gripping function to the full extent.
Diagnosis and progression
If Dupuytren’s disease is suspected, the primary care physician should first be consulted. This examines the hand first visually and palpates the complaints. Furthermore, the doctor will rule out other disorders, such as joint wear and tear. An X-ray examination can also be used for diagnosis. The course of the disease is usually gradual. At the beginning, hardly any significant complaints are noticed. Over time, however, the mobility of the fingers decreases significantly. In addition, both hands are often affected. If left untreated, the fingers or hand can no longer be stretched and remain in a permanently curved position.
Complications
Dupuytren’s disease causes the patient to experience various complaints and limitations in the hands.In most cases, the fingers are curved, so that the affected persons are severely restricted in their daily lives. Ordinary activities can then no longer be carried out without further ado. Sometimes patients are dependent on the help of other people. The quality of life is significantly reduced by Dupuytren’s disease. Psychological complaints and depression can also occur due to the limitations. The fingers are usually immobile and may also be affected by scars. Self-healing does not occur with this disease, so a doctor must be consulted in any case. In most cases, Dupuytren’s disease requires surgical intervention to relieve the symptoms. There are no complications. In many cases, however, the mobility of the fingers can only be restored temporarily, so that renewed interventions are necessary. Radiation therapy can also treat the symptoms and lead to a positive course of the disease. Life expectancy is usually not affected or reduced by Dupuytren’s disease.
When should you see a doctor?
When Dupuytren’s disease has occurred due to a benign growth, affected individuals will see a doctor on their own because of the inability to extend their fingers. However, it can take years for the flexion contracture of Dupuytren’s disease to fully develop. In the case of initial symptoms, sufferers usually do not go to the doctor. Many treat the noticeable hardening of the palm with massages or ointments. Often both hands are affected by Dupuytren’s disease. Usually, however, only certain fingers are restricted in movement. This also often prevents a visit to the doctor. Those affected learn to use their hands differently. Many adapt to their mobility restrictions. However, it is advisable to see a doctor early in the event of hand complaints, because this helps to rule out other diseases. Therapeutic measures include exercise training or surgical interventions. Often no treatment is necessary at all. Sometimes relief can be brought about by means of a needle fasciotomy or radiation.
Treatment and therapy
If movement of the fingers is restricted by more than 30 degrees as part of Dupuytren’s disease, surgery is generally performed. This can temporarily restore the mobility of the fingers. Different surgical methods are used. For example, the hardened tendon cords can be cut or the entire connective tissue plate of the hand can be removed. Experience shows that the success of the operation lasts longer if more tissue is removed. Often, however, the mobility of the fingers cannot be permanently preserved. Relapses occur relatively frequently, so that renewed interventions may be necessary. This is especially the case if the disease has already occurred several times in the family. In addition to surgical therapy, other treatment methods can be used for Dupuytren’s disease. The treating physician can inject an enzyme into the affected region, which dissolves the collagen and thus the hardenings. If the disease is detected at an early stage, X-rays (radiation therapy) may also be used. These prevent the proliferation of the nodule-forming cells. However, this treatment method can only be used for Dupuytren’s disease when the disease is in its early stages. At the later stage, X-rays remain ineffective.
Outlook and prognosis
Dupuytren’s disease is an incurable condition. However, thanks to comprehensive therapeutic measures, the prognosis is very good. Many patients do not develop contractures or other symptoms. It is sufficient to monitor the course of the disease and treat mild symptoms with medication. The affected hand can be treated surgically. Within the operation, the pathological connective tissue is completely removed, allowing free movement of the tendons. The quality of life can be significantly improved by such an operation. As a result, the patient’s sense of well-being also increases, as he may be able to continue his previous occupation and is no longer dependent on the help of other people. With early treatment, the prognosis is significantly better than with late-stage treatment, when the curvature of the fingers is already far advanced. Life expectancy is not reduced by Dupuytren’s disease.The recurrence rate, i.e. the probability that the disease will recur within five years, is up to 40 percent. The prognosis is made by the specialist in charge with regard to the condition of the fingers and tendons and the course of the disease to date.
Prevention
Since Dupuytren’s disease is a genetic condition, prevention in the true sense is not possible. However, anyone who observes signs in themselves that could indicate Dupuytren’s disease should see a doctor as soon as possible and have the cause of the symptoms clarified. If it is indeed Dupuytren’s disease, the chances of successful therapy are significantly greater if it is started early. The disease is not curable; however, the symptoms can be significantly alleviated and the progression slowed.
Follow-up care
Aftercare following surgery to treat Dupuytren’s disease is considered extremely important. It can take place both as an inpatient and as an outpatient. The patient’s cooperation plays a significant role in this process. The first follow-up treatment begins immediately after the operation. With the help of a plaster splint, the operated hand can be immobilized for a week. However, it must be possible to move the fingers in all joints. After the plaster splint, the patient usually receives a compression bandage. This counteracts the formation of swelling after the surgical intervention and at the same time ensures freedom of movement for the fingers. The stitches are removed about 14 days after the operation. It takes until the third week before the bandage can be removed. The patient then has the task of moving his fingers as independently as possible and without strain. If he cooperates well and follows the doctor’s instructions, he usually does not need physiotherapeutic treatment. If swelling occurs, it can be treated with lymphatic drainage. In order not to overstrain the treated hand, it is gradually reintroduced to everyday activities over a period of six weeks. For about 12 weeks, the patient must avoid heavy hand loads, and at the same time he or she should take advantage of occupational therapy exercises to animate the mobility of the finger. Regular application of a fatty cream to the scar tissue has proven to be a helpful measure.
What you can do yourself
In Dupuytren’s disease, the affected person can well counteract the shortening of the connective tissue himself. Daily and consistent practice is important. The two options for self-treatment include stretching the affected tissue and strengthening the finger extensors. Self-stretching of the palmar aponeurosis (connective tissue plate of the palm) can be preceded by gentle massage. Any massage oil is suitable here, as well as a drop of vegetable oil from the kitchen. With the thumb of the healthy hand, the palm of the affected hand can be stroked out along the metacarpal bone from the ring and little finger towards the fingertips and massaged in a circular motion. Afterwards, the curved fingers are gently pulled into length and thus straight. These exercises may be used in the bathtub, as the warm water promotes relaxation and facilitates self-stretching. After stretching, the fingers are actively stretched. The hand lies with the palm on a table top. Each finger is first lifted off the surface individually and held. At the end, all fingers are lifted off at the same time. The fingers should always be spread. To increase the resistance for the muscles even more, a rubber band can be stretched over all fingers. The person now tries to spread his fingers against the band.
