Dupuytren’s Contracture Surgery

Dupuytren’s contracture is a painless medical condition that makes fingers bend toward the palm. The knots of tissues formed under the skin can result in a thick cord that can easily pull the fingers toward the palm leading to Dupuytren’s contracture. 

The first appearance of reports of Dupuytren's contracture was seen during the 1600s, but the reasons that trigger these scar tissues to form and contracture to happen are yet to be found. 

It is necessary to seek medical help as soon as possible if you face this medical problem, as it may worsen with time. According to professionals, the affected fingers may never get straightened entirely. 

This medical condition mainly affects the last two fingers, which are far from the thumb. This condition can disturb your routine life and restrict you from performing your day-to-day activities, such as playing sports or completing your work. 

What is Dupuytren’s contracture?

Dupuytren's contracture is a medical condition wherein one or more fingers are bent towards the palm of the hand because of knots of tissues that are formed under the skin. In most cases, this condition is painless, yet it varies from person to person. 

This condition usually affects two fingers that are far from the thumb, namely the Ring finger and pinky finger. The movement of these two fingers is restricted, which makes it difficult for an individual to perform routine activities. 

Although Dupuytren's contracture is a painless medical condition, still it may cause permanent damage to the affected fingers, which can't be straightened completely for a lifetime. 

Because of the permanent bending of one or more fingers, it becomes difficult to perform day-to-day tasks and even sports activities. As the condition does not affect the thumb and index finger, an individual's ability to write and grab small things is intact.

It is a hereditary condition, which means it is possible that it might be transmitted to an individual by his/her parents. We mainly found this condition in adult men, especially of Northern European descent. In addition to that, additional factors and diseases such as alcohol, tobacco, diabetes, etc. increase the risk.

Signs & Symptoms

Early signs of Dupuytren's contracture include:

• Thickening of the skin on the palm.
• Nodules of hard tissue begin on the palm, which makes it look puckered.
• You might feel tenderness when you touch these knots.
• The condition of the palm and nodules is getting worse at a slow pace.
• A painless lump on the palm.

Given below is a list of symptoms of Dupuytren's contracture:

• Inability to place your hand on a flat surface with the palm facing downwards.
• One or more painless yet tender lump and nodules on the palm, wherein the tenderness goes away, eventually.
• Formation of thick bands of tissues under the skin caused by thickening and contracting of the knots in the palm.
• Bending of one or more fingers towards the palm of the hand.
• Inability to control the movement of one or more fingers.
• Not being able to straighten one or more fingers completely.
• Inability or difficulty in grasping heavy and big objects.
• Difficulty in performing routine activities.
• Formation of tough cords under the skin in the palm that restricts the movement of the affected fingers.

Causes

According to professionals, the cause of this medical condition is yet to be found. Although, it's clear that the condition is hereditary and is passed on by parents to children, and is more common in men as compared to women.

Find out some of the most common causes of Dupuytren’s contracture: 

1. Age: This medical condition mainly occurs after the age of 50.

2. Gender: Men are at a higher risk than women from Dupuytren's contracture. Signs & symptoms may be worse and the condition might get worse faster in the case of men.

3. Heredity: Dupuytren's contracture is a hereditary condition, which means it often runs in families.

4. Substance use: Consumption of alcohol and tobacco results in a highly inclined chance of developing this medical condition.

5. Work: According to some studies, there's a high chance of developing Dupuytren's contracture in those individuals who work with highly vibrating tools more often.

6. Medical history: There is a high risk of developing Dupuytren's contracture in individuals who face certain problems like diabetes and seizure disorders.

7. Origin: People who belong to northern Europe are at a higher risk of developing this medical condition.

Diagnosis

It is easy to diagnose Dupuytren's contracture just by its look and the feel of it. The bent-over finger/fingers towards the palm tell us that the medical condition is Dupuytren's contracture. In most cases, other tests and examinations aren't carried out, as the immobility of fingers and tenderness make it pretty evident.

Specialists compare both the hands of the patients in order to find out the differences and signs & symptoms of the medical condition, so they can choose the ideal form of treatment for the patient. 

While comparing hands, these specialists try to find out the plucking, course, and knots under the skin that are responsible for the contracture by applying pressure on the different parts of the hand.

In addition to that, they even carry additional tests out wherein your doctor will ask you to keep your hand with your palm facing towards a flat surface such as a table, and ask you to open your hand. 

If you're unable to open your hand and flatten your finger completely, then you might need to undergo surgery to get rid of the knots and cords that are lying under your skin and are responsible for your condition.

Treatment

There are mainly two methods of treatment that are opted for to cure Dupuytren's contracture:

1. Non-surgical methods: In this method, doctors usually try to take the help of other types of treatment and avoid surgery so that a patient's resources can be saved and they don’t have to bear much pain. This method of treatment consists of needling, steroids, and collagenase.

• Needling: In this method, a needle is inserted into the numbed skin to puncture the knots and break the cords that are responsible for the contracture. Despite having numerous advantages, we cannot use this method of treatment in some areas of the finger due to the risk of nerves/tendons getting damaged.

• Steroids: For prevention through steroids, it is injected into the lumps and knots that are causing the contracture. These steroids aid the contracture by making the lumps soft and flatten and even help in relieving the pain from the knots(If happens).

• Collagenase: Collagenase is a special enzyme that is injected into the hard knots and lumps to weaken and soften them. After injecting this enzyme, it shows its effect within a few days by breaking the contracture and allowing you to move your fingers. Opting for Collagenase can reduce the effect of contracture, and in some cases, it can also eliminate it for a few years.

2. Surgical method: Non-surgical methods are of no use if you have severe symptoms or your condition is getting worse. In that case, it is mandatory to opt for surgical methods to stop the worsening of your condition and to cure the contracture as soon as possible. 

By this method, they can remove the tissue or knots, causing contracture from the hand by performing surgery. The recovery after the surgery might take more time as compared to non-surgical methods, but the result is better and long-lasting, too. 

Management of Dupuytren’s contracture

Management varies as per the time of diagnosis. If the patient is diagnosed before any functional disability, then they can opt for conservative management to cure this disease. However, in the case of functional disability, thorough treatment methods are necessary.

• Conservative management: Doctors advise their patients to perform some hand exercises in order to keep their hands active. Several experts use CCM during the early stages of the disease so that it stops making progress rapidly and they can avoid the surgery. 

• Surgical management: Doctors opt for this type of management when the knots and cords responsible for the contracture are supposed to be removed from under the skin. They usually choose surgical management when there is a functional disability, speedily progressive disease, or MCP joint contracture.

Why choose Cutis Hospital for Dupuytren's contracture?

Thorough knowledge 

Cutis consists of specialists who have complete theoretical knowledge and years of practical experience regarding Dupuytren's contracture, as it is necessary to have complete knowledge regarding the different types of treatment available for curing this medical condition. 

Saves your resources 

It is necessary to diagnose the condition, and its stage properly so that we can select an appropriate method of treatment for the patient. Also, it is mandatory to ensure the stage of the disease so that we can cure it by non-surgical method, if possible. 

Doctors at Cutis only opt for surgical treatment methods when it is inevitable. Otherwise, they try to fix the condition by non-surgical techniques such as needling and injections to save the patient’s resources and offer best-in-class treatment.

Eye-to-detail 

It is necessary to take care that the nerves and tendons are intact while opting for the Needling technique. Otherwise, the condition might become more complicated and worse. It is also necessary to have knowledge of the number of steroids to be given so that it does not result in any side effects or long-term internal damage. The specialists always keep these factors in mind at Cutis to ensure the safety of patients.

Consult the experts at Cutis Hospital & get the best treatment at your earliest convenience.