Dupuytrens Contracture

Dupuytren’s Contracture

Dupuytren’s contracture is a condition typified by an unusual thickening of the tissue just underneath the skin which may lead to lumps in the palm, curled fingers and trouble in grasping objects. The ring and small fingers are the most commonly affected. ^{[1] [2]}

Epidemiology

Recorded prevalence is 4% in the United States and 3% in Asian region. Majority of the affected are males who are usually in their fifth to sixth decade of life. The incidence of the disease has been observed to increase with advancing age. ^[3]

Causes

The exact mechanism remains unknown but the fundamental pathophysiology deals with fibroblast proliferation and collagen deposition. Among the suggested risk factors that raise a person’s chance of developing the condition include being male, hand trauma, diabetes mellitus, positive family history, high lipid levels, occupation involving vibration exposure, cigarette smoking and high alcohol intake. ^[3]

Signs and Symptoms

Affected people often complain of thickening sensation on the surface of the palm or sometimes on the finger areas particularly the ring finger. The sensation may be present over years. The patients may have decreased range of movement and may have trouble performing activities like handshaking and putting the hands into pockets. Lumps or nodules may develop in the palms and fingers may bend towards the palmar area. ^{[1] [2]}

Diagnosis

After getting the patient’s history, the physician typically conducts a physical examination which involves visual inspection of the hand, testing and feeling the areas involved and assessment of grip strength. ^[2] In most cases, laboratory exams are rarely needed. If they are, tests may include histological analysis of lesions and ultrasonography. ^{[3] [4]}

Treatment

In mild cases, mere observation is needed. Follow up consultation for monitoring of the condition can be done every 6 to 12 months. Some patients may be advised to undergo physical therapy and occupational therapy. To enhance movement capabilities of the person, assistive devices may be utilized. When the condition is serious enough, the patient may undergo treatment procedure such as collagenase injection and needle aponeurotomy. Open surgery may be recommended in some cases. ^{[1] [3]}

References:

1. http://www.assh.org/Public/HandConditions/Pages/DupuytrensDisease.aspx
2. http://orthoinfo.aaos.org/topic.cfm?topic=a00008
3. http://emedicine.medscape.com/article/329414-overview#a0199
4. http://www.mayoclinic.com/health/dupuytrens-contracture/DS00732/DSECTION=tests-and diagnosis

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Heat Therapy:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present. 

Recommendation: No recommendation (There is insufficient evidence to support claims that heat therapy is able to help treat Dupuytren’s Contrature)

Grade of Evidence: Very low quality of evidence

* www.gradeworkinggroup.org

Public Discussion