Symptoms

The disease often begins with the so-called falling asleep and “formication” (= tingling) on the tip of the middle finger. The symptoms are triggered by a one-sided position of the wrist when making a phone call, riding a bicycle, etc. A short time later the patient has the feeling of a swollen hand.

Pain is felt in the whole hand, possibly also in the forearm. The above-mentioned pains occur preferably at rest, and therefore particularly frequently at night. Since Dupuytren’s disease belongs to the group of fibromatoses, the formation of knots and strands is also found in this disease.

Over time, these nodules and hardenings shrink increasingly. This results in a bending of the fingers, which can lead to a functional impairment and pain. At the maximum degree of symptomatology, there is a pronounced bending contracture of the proximal (near-body) interphalangeal joints (interphalangeal joints) and simultaneously an extension of the distal (distal) interphalangeal joints (interphalangeal joints).

This maximum expression of Dupuytren’s disease is also called buttonhole deformity and develops over many years. In the course of the disease, it does not only remain with the pain and discomfort that occurs at night. Increasingly, the symptoms also occur during the day.

Patients often report “clumsiness” and sudden “weakness” of the hand. The sensitivity of the skin on the thumb, index, middle and ring fingers is increasingly reduced. In later stages, the thumb ball musculature can be lost.

Fortunately, the complete loss of skin sensitivity in the hand occurs very rarely today. Usually, the knotty changes and hardenings can be felt for years without further symptoms. In some cases, the nodular changes can even recede over time.

Gradually, however, strands develop along the tendons, which consist mainly of collagen fibers. The strands increasingly prevent the fingers from being stretched and thus lead to the typical bending contracture of Dupuytren’s disease. In order to choose the right therapy, Dupuytren’s contracture is divided into different stages.

The extension deficit is measured as deviation from the normal position. To be able to measure the total deficit of the affected finger, the deficit over each joint of the affected finger is measured and the individual extension deficits are added together to form a total deficit. This definition goes back to Tubania.

In the initial stage, this definition was expanded. From the third stage onwards, the contracture can be so severe that the resulting skin folds can no longer dry out and become inflamed.

Stage 0 indicates a healthy hand.
In stage N there is no stretch deficit yet, but knots and strands are already palpable.
In stage N/I, there is an incipient flexion contracture of 1-5 degrees.
In stage I the contracture is between 6- 45 degrees.
In stage II a contracture between 46 and 90 degrees is described,
In stage III between 91 and 135 degrees.
All contractures with an extension deficit greater than 135 degrees are assigned to stage IV.