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Summary

Dupuytren's contracture is a shortening and thickening ofthe palm's tissue that results in clawing of the fingers. 

The cause is unknown, but it is thought to have a
hereditary component. Other risk factors include advancing age and certain conditions, such as alcoholism, epilepsy and diabetes. Treatment includes a range of
therapies or surgery.

The palm of the hand contains a deep layer of tissue called the palmar fascia, which extends across the palm to the fingers. Dupuytren's contracture is a thickening and shortening of this web of fascia that gradually causes clawing of the fingers as they are pulled towards the palm. The ring and little finger are usually targeted, but any finger can be affected.

The disease tends to progress in fits and starts, and may take decades to finally limit the functioning of the hand. The exact cause is unknown, but the incidence of Dupuytren's contracture is higher among certain groups including: 
            Older males. 
            People with diabetes. 
            People with epilepsy who are treated with   
            phenytoins (epilepsy medication). 
            People who abuse alcohol.
    

Dupuytren's contracture can sometimes run in families, which suggests a genetic susceptibility. Treatment depends on the severity of the condition, but may include injections of corticosteroids into the palm and surgery.

Symptoms of Dupuytren's contracture


The features include:
            A lump or nodule appears on the palm, usually  
            close to the base of the ring or little finger.
            There is the appearance of a thickened cord   
            running along the palm to the fingers. 
            Over time, as the contracture develops, the  
            fingers become clawed as they are pulled towards
            the palm.

            The hand bows. 
            
The fingers are completely pulled against the 
            palm.

            Often, the skin of the palm is dimpled and 
            puckered.

            There is rarely any associated pain.


The cause of Dupuytren's contracture


The exact trigger that causes the palmar fascia to thicken and contract is unknown. However, contributing factors may include: 
           Age – the condition is more common in middle  
           to later years of life.
           Gender – up to 10 times more males than 
           females are affected. 
           Heredity – the condition tends to run in families.

           Ancestry – those with Celtic or Scandinavian 
           ancestry are at increased risk.

           Certain medical conditions - people with 
           diabetes and epilepsy have a higher incidence of 
           the condition. 

           Alcoholism – the contracture tends to be 
           common, and comparatively more severe, in 
           alcoholics.

Associated conditions


In most cases, only the hands are affected.

Other associated difficulties can include:

           Garrod's pads – the finger joints on the same 
           hand may enlarge and thicken.

           Ledderhose disease – creates thickening and
           shortening of the foot’s deep connective tissue.   
           As the disease progresses, it can cause quite  
           severe pain while walking. 

           Peyronie's disease – there may be
           thickening and shortening of tissue in the penis.

 
Treatment options for Dupuytren's contracture


Treatment depends on the severity of the condition. In its earlier stages, treatment may include injections of corticosteroids into the fascia. These medications reduce any localised tenderness and may help to delay  subsequent thickening of the tissue.

More recent treatments showing promise include therapy with calcium channel blockers, treatment with gamma-interferon and percutaneous needle fasciotomy.

In severe or advanced cases, the person is unable to lay their hand palm-down on a flat surface, or their fingers have contracted into their palm so that the hand is no longer functional. Surgery is then the best option. 

Dupuytren's contracture can sometimes return after surgery, either at the same site or elsewhere on the palm. Usually, the contracture progresses at the same speed as previously.


Surgical techniques


Depending on the severity of the condition, the surgery options may include:
            Cutting the fascia bands through small incisions  
            in the palm .

            Removing the thickened fascia.

            Removing the fascia and associated skin, and 
            using a skin graft to seal the palm.

            Amputation of an affected finger, if the 
            contracture has returned so many times that 
            corrective surgery is no longer possible.

Occupational therapy


Occupational therapy is needed after surgery to speed recovery and reduce the risks of the contracture returning. Techniques may include: 
            Splints worn at night for a few months to 
            straighten the finger. 

              Sometimes, a splint worn during the day.

            Special hand exercises to encourage flexibility.

            Gentle massage with moisturising hand cream.





 
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