Dupuytren’s contracture, a French disease or palmar fibromatosis, call cicatricial deformities and shortening of the tendons in the hand, which lead to flexion and fixation of the fingers in an unnatural position and the impossibility of completely unbending them. Most often, the little finger and ring finger on one or both hands are affected.
Dupuytren’s contracture is typical mainly for middle-aged men, occurrence at a young age is rare, but it proceeds faster and leads to persistent and severe deformities of the hand. As the age increases, the number of cases of Dupuytren’s contracture increases, and the disease itself slowly progresses. Most of all people from Europe, Ireland and the Scandinavian countries suffer from it.
Mainly with Dupuytren’s contracture, it affects:
- palmar surface of the brush on one or both hands,
- describes the lesion of the sole,
- the interphalangeal joints on the hands are somewhat less affected,
- rarely affects the cavernous bodies of the penis.
At present, the exact cause of the disease has not been clarified, but in families with Dupuytren’s contractor, hereditary predisposition can be traced. Usually the gene is transmitted on the X chromosome with incomplete dominance, and therefore, it manifests itself more actively in men.
Several theories of the origin of Dupuytren’s disease are being advanced :
- injuries to the hand and individual fingers,
- neurogenic origin of the deformity (pinching of the nerves going to the hand and fingers),
- endocrine disorders
- a hereditary defect in the connective tissue
- physical brush overload,
- inflammation of the ligaments, the past is imperceptible , but yet to leave the consequences.
It is believed that Dupuytren’s contracture is characteristic not only of the hand, but also of the entire connective tissue of the body, with a “favorite” location in the hands.
Predisposing factors for the development of Dupuytren’s disease are:
Normal brush is able to completely bend and unbend all fingers. With the defeat of Dupuytren’s contracture, the palmar ligament of each finger shrinks and makes it impossible to completely unbend a finger. At the same time, a violation of the movement in the joints of the affected fingers, up to their complete immobility. In this case, ankylosis is formed – the articular surfaces grow together. Knots are formed on the surface of the palm in the projection of the tendons. They can be painful.
Based on where the lesion initially develops, there is a palmar, finger, mixed form of Dupuytren’s contraract.
Dupuytren’s contracture is a stage disease, there are four stages of damage.
At the first stage, there are:
- subcutaneous seal in the palm area,
- finger movements are almost unlimited,
- changes do not interfere with normal life,
- no significant cosmetic defects.
In the second stage usually occur:
- the restriction in the passive extension of the fingers is not more than 30 degrees,
- slight limitation in brush functions,
- no pain
- There is a full and pronounced effect from operations.
At the third stage is formed:
- the defect in the extension of the finger leaves from 30 to 90 degrees,
- finger constantly bent
- there is pain in the hand,
- markedly impaired brush function,
- There is no full effect during the operation; the extension defect can not be completely eliminated.
At the fourth stage occurs:
- the transition of the pathological process to the tendons and joints,
- persistent finger changes
- accretion of articular surfaces (contractures),
- lack of extension of the fingers is more than 90 degrees, the finger is almost unbent,
- Surgical treatment is not very effective. But often it is necessary to perform several complex operations.
- the brush is severely deformed and cannot perform its functions.
Preliminary diagnosis is based on the examination and questioning of the patient, ascertaining the presence of such anomalies in relatives.
The degree of deformation and the ability of the hand to perform actions, the angle of extension of the fingers and the presence of nodules in the area of the tendons of the hand are determined. Basically, with an obvious clinical picture, additional diagnostic methods are not required.
Orthopedic surgeons are engaged in treatment. There are two areas of treatment – conservative therapy and surgical methods.
The choice of method depends on the severity and duration of the disease, as well as on how limited the mobility of the joints and the function of the hand.
The basis of the choice of treatment is the degree of tendon changes in the palm area, which the doctor probes, the size of the lesion and the condition of the surrounding tissue on the palm.
Conservative methods include:
- physiotherapeutic thermal procedures (paraffin, ozokerite).
- stretch tendon exercises
- overlaying the longget in the maximum unbent position of the fingers at bedtime,
- ultrasound treatment
- corticosteroid injections.
- therapeutic blockade of local anesthetics with hormones.
Conservative therapy can only slow down the course of Dupuytren’s contracture. But not to stop it, sooner or later surgical correction will be required.
Surgical methods include needle aponeurotomy (removal of nodules with special needles).
The operation is shown when the finger reaches the angle of flexion, which is already limited to 30 degrees. In this case, the tendinous fascia and pathological cords are excised completely or partially.
For pronounced changes, arthrodesis is performed – they make a finger straight, but with a fixed joint. In very severe cases, when the connective tissue has greatly grown and struck the nerves and blood vessels, there may even be a finger amputation.