Dupuytren's contracture

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Dupuytren's contracture
Dupuytren's contracture affecting the hand
Synonyms	Morbus Dupuytren, Viking disease
Pronounce	N/A
Specialty	Orthopedic surgery, Rheumatology
Symptoms	Flexion contracture of the fingers, nodules in the palm
Complications	Limited hand function
Onset	Typically after age 50
Duration	Long-term
Types	N/A
Causes	Unknown, possibly genetic
Risks	Family history, alcoholism, diabetes, smoking
Diagnosis	Physical examination
Differential diagnosis	Trigger finger, tenosynovitis
Prevention	None known
Treatment	Needle aponeurotomy, collagenase injection, surgery
Medication
Prognosis	Variable, may recur after treatment
Frequency	Common in people of Northern European descent
Deaths	N/A

Dupuytren's contracture is a medical condition characterized by the progressive thickening and tightening of the fibrous tissue layer underneath the skin of the palm and fingers<ref>,

 Injectable collagenase Clostridium histolyticum for Dupuytren's contracture., 
 The New England journal of medicine, 
 
 Vol. 361(Issue: 10),
 pp. 968–79,
 DOI: 10.1056/NEJMoa0810866,
 PMID: 19726771,</ref>. Named after the 19th-century French anatomist Baron Guillaume Dupuytren, this condition can lead to significant physical impairment by restricting the affected individual's ability to fully extend their fingers.

Xiaflex (Collagenase) for Dupuytrens

Pathophysiology

The exact cause of Dupuytren's contracture remains unknown, but it is thought to involve an abnormal wound healing process<ref>,

 Scientific understanding and clinical management of Dupuytren disease., 
 Nature reviews. Rheumatology, 
 
 Vol. 6(Issue: 12),
 pp. 715–26,
 DOI: 10.1038/nrrheum.2010.180,
 PMID: 21135877,</ref>. Specifically, myofibroblasts, a type of cell responsible for wound healing, appear to be excessively active in the palmar fascia. This excessive activity results in the formation of nodules and cords that eventually lead to finger contractures.

Risk Factors

Certain risk factors are associated with Dupuytren's contracture, such as Northern European descent, male gender, age over 50, family history of the condition, diabetes mellitus, smoking, and alcohol consumption<ref>,

 The hand in hypertrophic osteoarthropathy., 
 The Journal of rheumatology, 
 
 Vol. 13(Issue: 1),
 pp. 142–7,
 
 PMID: 3958080,</ref>. It is also more common among people with epilepsy, possibly due to the use of anticonvulsant medications.

Clinical Presentation

Patients with Dupuytren's contracture commonly present with a thickened nodule in the palm, which can lead to puckering of the skin. As the disease progresses, contractures develop and the affected fingers may become flexed towards the palm, usually affecting the ring and little fingers. Despite its appearance, the condition is usually not painful, although it can cause discomfort and hinder hand function.

Diagnosis

The diagnosis of Dupuytren's contracture is typically made clinically, based on the characteristic physical findings. However, ultrasound or magnetic resonance imaging (MRI) can be used to assess the extent of the disease<ref>,

 Connective tissue growth factor (CTGF/CCN2) enhances lactogenic differentiation of mammary epithelial cells via integrin-mediated cell adhesion., 
 Molecular Endocrinology, 
 
 Vol. 24(Issue: 6),
 pp. 1148–64,
 DOI: 10.1210/me.2009-0385,
 PMID: 20363875,</ref>.

Treatment

Treatment for Dupuytren's contracture is generally indicated when the disease interferes with the patient's daily activities. Non-surgical options include splinting, physical therapy, and injections of collagenase or corticosteroids to break down the fibrous tissue<ref>,

 The treatment of Dupuytren's disease., 
 Journal of hand surgery, 
 
 Vol. 20(Issue: 3 Pt 2),
 pp. S57-62,
 DOI: 10.1016/s0363-5023(05)80023-4,
 PMID: 7639619,</ref>.

Surgical intervention, such as a procedure called fasciotomy where the thickened connective tissue is divided, may be necessary in severe cases to improve finger motion. In more advanced cases, fasciectomy, the surgical removal of the affected tissue, may be required<ref>,

 A systematic review of outcomes of fasciotomy, aponeurotomy, and collagenase treatments for Dupuytren's contracture., 
 Hand (N Y), 
 
 Vol. 6(Issue: 3),
 pp. 250–5,
 DOI: 10.1007/s11552-011-9330-4,
 PMID: 22942826,
 PMC: 3160302,</ref>.

Prognosis and Follow-up

The prognosis of Dupuytren's contracture is generally good, especially with treatment. However, it's important to note that the disease is chronic and recurrent. Regular follow-ups are necessary to monitor the progress of the disease and the effectiveness of the treatment. Rehabilitation following surgical procedures is essential to optimize hand function.

Summary

Dupuytren's contracture is a common condition that can significantly affect hand function, primarily in men of Northern European descent. Early diagnosis and appropriate treatment are key to maintaining optimal hand function and quality of life. Research continues to uncover the underlying pathophysiological mechanisms, with hopes of developing more effective therapeutic options in the future.

See also

• Fibromatosis
• Plantar fibromatosis
• Peyronie's disease

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