Dupuytren's contracture 4.71/5 (7)

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Dupuytren's contracture

Dupuytren's contracture (hook finger). Illustration: Frank C. Müller (https://creativecommons.org/licenses/by-sa / 4.0)

Definition

Dupuytren's contracture is due to hard connective tissue (fibrosis) contracting in parts of the palms. The symptoms begin with a painless, knotty thickening just below the skin over the bend of the ring finger or small finger. Gradually, the connective tissue thickens and contracts over the tendons so that one or more fingers cannot be stretched.

Occurrence

Very common condition, but different degrees. Rarely before the age of 50. Most common among white men, especially in Scandinavia.

  • Among men over the age of 65, Dupuytren's contracture may occur at the entire 30%
  • There is an increased incidence among people with diabetes mellitus

Disease Cause

One does not know why anyone gets the condition. Risk factors are similar in the immediate family and diabetes mellitus. Once the disease has begun, increased connective tissue is formed in the palm. One has shown that the connective tissue in the palm (palmar fascia) usually consists of collagen type I, but by Dupuytren's contracture, collagen type III develops which is thicker.

Dupuytren's contracture

Dupuytren's contracture, most clearly on the finger 4 left hand. Illustration: Raina S, Jaryal A - Indian J. Med. Res. (2012). CC BY-NC-SA3.0

Symptoms

Dupuytren's contracture begins as a hard, not painful knot in the palm, most often within the ring finger

  • The thickness is connected to the skin and is best recognized when the fingers are stretched
  • Gradually, the thickening increases and extends outward toward the fingers. At the same time, the stretching ability of the fingers is reduced.
  • Ring finger (finger 4) and little finger (finger 5) are most commonly attacked.
Dupuytren's contracture

Dupuytren contracture with 90 degrees contracture in small finger. Howard JC, Varallo VM, Ross DC, Roth JH, Faber KJ, Alman B, Gan BS - BMC Musculoskeleton Disord (2003). Open-in

Diagnosis

The medical history and clinical examination are usually sufficient

Incorrect diagnosis (similar conditions, differential diagnosis)

Treatment

In early stages, injection of clostridium collagenase is effective. This is an enzyme that breaks up collagen which is an essential part of the connective tissue.

At an early stage, connective tissue can also be loosened by means of a needle (needle monkey rotomy).

In more extensive disease stages, surgical treatment is appropriate, often if it is missing 30-40 degrees or more at full stretch in the base joint (MCP) or above 20 degrees in the middle joint (PIP)

Prognosis

Dupuytren's contracture does not damage the internal organs and does not affect the life span. The condition is not painful, but the hand function is gradually reduced. The symptoms do not go away by themselves. If one or more fingers are severely attacked, "hook fingers" can inhibit dressing and otherwise be embarrassing. After any treatment, relapse is not uncommon.

Literature


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