Dupuytren’s disease or Dupuytren’s contracture is a disease that causes changes in the connective tissue of the hands. The fingers curve more and more towards the palm of the hand. As a result, those affected can no longer use their hands properly and experience a significant restriction in their everyday life.
What is Dupuytren’s disease?
Doctors understand Dupuytren’s disease to be a pathological change in the connective tissue plate in the hand. Basically, the healthy connective tissue has a fibrous structure at this point. However, the disease hardens it, 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. See lawfaqs for Definitions of Mineral Deficiency.
As a result, one or more fingers curve towards the palm of the hand and ultimately can no longer be stretched. Pain does not usually occur in Dupuytren’s disease; However, the hands of those affected are significantly restricted in terms of motor skills, especially later in the course of the disease.
Both hands are often equally affected by the disease. Dupuytren’s disease usually occurs between the ages of 40 and 60, with men more frequently affected than women. According to statistics, around 1.3 to 1.9 million people in Germany suffer from Dupuytren’s disease.
Causes
The causes of Dupuytren’s disease are only recently known. The fact that the disease occurs more frequently in some families has long indicated that a genetic predisposition could be decisive for the tissue change.
Recent research has shown that the disease is caused by a genetic mutation. The regions of the genes responsible for signal transmission in the cells are particularly affected. If certain signaling pathways are disrupted, the connective tissue cells are transformed into another cell type that is responsible, among other things, for wound healing and collagen formation.
This is deposited on the flexor tendons of the fingers and thus ensures permanent hardening. Dupuytren’s disease initially occurs gradually and in flares, which makes it difficult to recognize the disease early. In the long term, however, there are significant limitations in the movement of the fingers. Doctors divide the course of the disease into different stages. Finger extension can be affected anywhere from 0 to 135 degrees as the disease progresses.
Symptoms, Ailments & Signs
Dupuytren’s disease initially manifests itself as a nodular thickening at the metatarsophalangeal joint of the little or ring finger. Due to an overgrowth of the connective tissue tendon plate on the palm of the hand, the affected fingers are increasingly retracted. Men suffer from this benign tumor much more often than women.
This is initially not painful, at most uncomfortable. And it makes it difficult to stretch your fingers. In the course of time it becomes more and more difficult to open the fingers as the tissue becomes increasingly short and hardened. Significantly thickened strands can be felt in the palm of the hand instead of knots.
Indirectly affected joint capsules also shorten due to the lack of stretching. Blood vessels and nerves are hampered in their function by the constant bending of the fingers. In rare cases, pain may occur. These usually occur when a nerve is trapped in one of the connective tissue nodes.
If the contracture is left untreated for a long period of time, the affected fingers can retract until they rest against the palm of the hand and can no longer be straightened. This leads to a significant impairment in everyday activities, since the hand can no longer fully fulfill its gripping function.
Diagnosis & History
If you suspect Dupuytren’s disease, you should first see your family doctor . The doctor first examines the hand visually and scans the symptoms. The doctor will also rule out other diseases, such as joint wear and tear. An X-ray examination can also be used for diagnosis.
The course of the disease is usually insidious. At the beginning there are hardly any significant complaints to be noticed. However, over time, 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 bent position.
Complications
Patients with Dupuytren’s disease experience various complaints and limitations in their hands. In most cases, the fingers become crooked, so that those affected are severely restricted in their everyday life. Normal activities can then no longer be carried out without further ado. Sometimes patients need help from other people.
Quality of life is significantly reduced by Dupuytren’s disease. Mental health problems and depression can also occur as a result of the restrictions. The fingers are usually immobile and can also be affected by scars. Self-healing does not occur with this disease, so that a doctor must be consulted in any case.
In most cases, Dupuytren’s disease requires an operation to resolve the symptoms. There are no complications. In many cases, however, the mobility of the fingers can only be restored temporarily, so that further 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 go to the doctor?
If a benign growth has caused Dupuytren’s disease, those affected go to the doctor on their own because they cannot straighten their fingers.
However, it can take years for the flexion contracture of Dupuytren’s disease to develop fully. When the symptoms begin, those affected usually do not go to the doctor. Many treat the noticeable hardening of the palms of the hands with massages or ointments. Both hands are often affected by Dupuytren’s disease. In most cases, however, only certain fingers are restricted in their movement. This often prevents you from seeing a doctor. Those affected learn to use their hands differently. Many adapt to their mobility limitations.
However, it is advisable to see a doctor early if you have problems with your hands, because this can rule out other diseases. Therapeutic measures include movement training or surgical interventions. Often no treatment is necessary at all. Sometimes a needle fasciotomy or radiation can provide relief.
Treatment & Therapy
If the movement of the fingers is restricted by more than 30 degrees as part of Dupuytren’s disease, an operation is generally carried out. This can temporarily restore the mobility of the fingers. Different surgical methods are used. For example, the hardened tendon strands can be severed or the entire connective tissue plate of the hand can be removed.
Experience shows that the success of the operation lasts longer when more tissue is removed. Often, however, the mobility of the fingers cannot be maintained permanently. Recurrences are relatively common, so that repeated interventions may be necessary. This is particularly the case if the disease has already occurred several times in the family. In addition to surgical therapy, other treatment methods can also be used for Dupuytren’s disease.
The doctor treating you can inject an enzyme into the affected region, which dissolves the collagen and thus the hardening. If the disease is detected at an early stage, X-rays (radiation therapy) can 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. Later on, X-rays remain ineffective.
Outlook & Forecast
Dupuytren’s disease is an incurable disease. However, thanks to comprehensive therapeutic measures, the prognosis is very good. Many patients do not develop contractures or other symptoms. It is enough to monitor the course of the disease and treat mild ailments with medication. The affected hand can be treated surgically.
During the procedure, the diseased connective tissue is completely removed, allowing the tendons to move freely. The quality of life can be significantly improved by such an operation. This also increases well-being, since the patient may be able to continue working in their previous job and no longer depend 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 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 specialist doctor responsible makes the prognosis with regard to the condition of the fingers and tendons and the previous course of the disease.
Prevention
Since Dupuytren’s disease is a genetic disease, it cannot actually be prevented. Anyone who observes signs that could indicate Dupuytren’s disease should consult a doctor as soon as possible and have the cause of the symptoms clarified. If it is actually Dupuytren’s disease, the chances of successful therapy are significantly higher if it is started early. The disease is not curable; However, the symptoms can be significantly alleviated and the course slowed down.
Aftercare
Follow-up care after surgery to treat Dupuytren’s disease is considered extremely important. It can be done on an inpatient or outpatient basis. The cooperation of the patient plays an important role in this. The first follow-up treatment begins immediately after the operation. The operated hand can be immobilized for a week with the help of a plaster splint.
However, the fingers must be able to move in all joints. After the splint, the patient is usually given a compression bandage. This counteracts the formation of swelling after the surgical procedure and at the same time ensures freedom of movement for the fingers.
The stitches are removed around 14 days after the operation. It will take up to 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 physiotherapy treatment. If swelling occurs, it can be treated with lymphatic drainage.
In order not to overwhelm the treated hand, it is gradually reintroduced to everyday stress over a period of six weeks. For approximately 12 weeks, the patient must avoid heavy hand strains while engaging in occupational therapy exercises to encourage finger mobility. Regular care of the scar tissue with a fatty cream has proven to be a helpful measure.
You can do that yourself
In the case of Dupuytren’s disease, the person affected can counteract the shortening of the connective tissue themselves. Daily and consistent practice is important. The two self-treatment options include stretching the affected tissue and strengthening the finger extensors.
A gentle massage can precede the stretching of the palmar aponeurosis (connective tissue plate of the palm). Any massage oil is just as suitable here 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 along the metacarpal bone of the ring and little fingers in the direction of the fingertips and massaged in a circular motion. Then the curved fingers are gently stretched and thus straightened. You are welcome to do these exercises in the bathtub, as the warm water promotes relaxation and facilitates self-stretching.
After the stretch, the fingers are actively stretched. The hand lies palm down on a table top. Each finger is first lifted and held individually from the surface. 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, a rubber band can be stretched over all fingers. The affected person now tries to spread his fingers against the band.
