Are your fingers curling inwards? Is this Dupuytren's Contracture?

Have you ever noticed that there is a small lump under the skin of your hand? Or do you feel like one of your fingers, especially your ring finger or little finger, is gradually bending towards the palm? Have you ever tried to place your hand on a table and couldn’t put it down completely, but one finger was sticking up? If this has happened to you, then it is very important for you to be aware of the condition we are talking about today, namely Dupuytren Contracture. Don’t worry, it is not cancer. Let’s take a look at what it is, why it happens, and what can be done about it.

Simply put, what is Dupuytren Contracture?

Imagine, under the skin of our palm, there is a network of membranes, like a rubber band, that gives strength to our hand and fingers. In medicine, we call this fascia . In a condition called Dupuytren's contracture, the tissue in this fascia gradually thickens, tightens, and begins to contract. It starts with small knots (doctors call these nodules ) that form under the skin of the palm. Over time, these knots join together and become thick, cord-like bands. As these cord-like bands contract further, the fingers that are connected to them begin to pull inward. Eventually, the finger bends inward so much that it is impossible to straighten it. This bending of the fingers is what we call a contracture .

Who is affected the most by this situation?

Anyone can develop Dupuytren's contracture, but some people are more likely to develop it.

• For men: This condition is more common in men than women.
• For those of European descent: This is more common among people of European descent compared to other ethnicities.
• Family history : If someone in your family has had this condition before, you may have a genetic predisposition to developing it too.

Relationship with other medical conditions

People with certain medical conditions may be slightly more at risk of developing Dupuytren's contracture.

• Diabetes​
• Epilepsy and seizure disorders
• Alcohol use disorder
• HIV and AIDS
• Vascular disease

How does this affect my body?

Most of the time, this condition develops very slowly. It can take months or years for symptoms to become severe. You may not notice any problems at first. Some people develop a small lump on their hand that doesn't grow beyond that point. However, in the later stages of the disease, people can become unable to straighten their fingers, making it difficult to perform everyday tasks. For example, even simple tasks like shaking hands, reaching into a pocket, putting on socks, or washing their face can be challenging. Although it can affect any finger, the most common order is: 1. Ring finger 2. Pinkie finger 3. Middle finger 4. Index finger 5. Thumb

What are the symptoms? How do we recognize this?

Dupuytren's contracture usually develops in several stages. Not everyone experiences all of these stages. Some people may stop at the first stage.

Other additional symptoms

In addition to these main symptoms, some people (not everyone) may also experience the following:

• Swelling or inflammation in the hand
• Tenderness when touched
• Burning pain
• An itch

These symptoms are very rare. If you have Dupuytren's contracture and experience these symptoms, it is important to tell your doctor.

A simple test you can do yourself: the "Tabletop test"

There is a simple way to tell if your symptoms are getting worse. Place your palm on a flat table with your palm facing the floor. Now check to see if your palm and all of your fingers are fully touching the table surface. If any of your fingers are raised and unable to be placed on the table surface, it means that your condition may have reached the contracture stage. If so, it is a good time to see a doctor and discuss treatment.

What is the reason for this?

Experts haven't found a specific cause for this yet. But it has been proven that this is a genetic disorder . That means it can be passed down from generation to generation. So it's not your fault. If someone in your family has it, you're more likely to get it too.

How does a doctor diagnose this?

A doctor can usually diagnose this condition just by examining your hand.

• He looks at your hand, touches it, and examines it.
• Feel for nodules and cords under the skin.
• They measure how far your fingers can be bent and straightened.

This usually does not require special tests or X-rays. However, if there is any doubt about the cause of your arm pain, an X-ray or blood test may be ordered to rule out other conditions.

What are the treatments?

There are several treatments available, depending on the severity of your symptoms. Because it progresses very slowly, it can take years to progress from one treatment to the next. You may be able to get better with simple treatments in the early stages and not need any further treatment.

1. Simple and basic treatment (Conservative treatment)

These are the first things to try.

• Physical therapy : Special exercises to stretch the fingers.
• Bracing or splinting:A device worn to keep the fingers extended.
• Ultrasonic or heat therapy: Uses painless sound waves or heat to increase the flexibility of the thickened tissue (fascia).
• Corticosteroid injections: An injection given to shrink the nodules and bands.

2. Radiation Therapy

In some cases, a radiation specialist may be referred to stop or slow the progression of symptoms. This involves using very low doses of radiation, such as X-rays, to soften the nodules.

3. Needle aponeurotomy

If simple treatments don't work, this is the next thing to consider. This is something that can be done in the doctor's office. Here, the hand is numbed, and a special needle is used to pierce the tight cords, loosening them. Then the finger can be straightened again.

4. Collagenase injections

Collagenase is an enzyme that helps break down the thickened tissue. The doctor injects an injection containing this enzyme directly into the knots or bands. Then, one day, the hand is numbed and the finger is straightened.

5. Surgery (Dupuytren contracture surgery)

If your finger flexion is severe enough to interfere with your daily activities, surgery may be the last resort. This is also usually an outpatient procedure. This procedure is called a fasciectomy. In this procedure, the surgeon numbs your hand and removes part or all of the thickened, contracted fascia tissue. After surgery, physiotherapy is often necessary to help regain strength and movement in your hand.

Is there a permanent cure for this?

No, there is no cure for Dupuytren's contracture. However, it is a very manageable condition . With treatment, you can get rid of the symptoms and live a normal life. However, because it is genetic, there is a small chance that it will recur after treatment, perhaps years later. If that happens, you can repeat the same treatment as before.

How quickly will I feel better after treatment?

• Simple treatments: Things like exercises and splints can take several months to see results.
• Needle aponeurotomy: The finger can be straightened almost immediately after the treatment.
• Surgery:Even if the surgery eliminates symptoms, it can take up to two months to feel fully recovered. You need to wait until your hand heals. After that, you will need to do physical therapy for a few months.

When should I see my doctor?

If you notice a lump in your palm, or if you feel like your finger is bending, it's a good idea to see a doctor. Especially if you can't place your palm completely flat on the table after doing the "tabletop test" we talked about earlier, it's time to start treatment.

Are there times when I should go to ETU?

Go to the Emergency Department (ETU) immediately if the following happens, such as after surgery.

• Very severe pain
• Excessive swelling of the hand
• Hand discoloration
• Inability to shake hands normally
• If there is bleeding from the surgical site

Are Dupuytren Contracture and Trigger Finger the same thing?

No. Although both of these can cause a finger to bend, they are two completely different conditions.

• Dupuytren's Contracture: It occurs due to thickening of the fascia under the skin of the palm.
• Trigger Finger: This is caused by swelling of a 'pulley' (A1 pulley) that helps move the tendon in the finger. This causes the finger to feel like it is stuck when you bend or extend it.

No matter what problem you have with your hand, it's best to see a doctor for advice as soon as you notice any new symptoms, especially if there is pain or difficulty moving. dupuytren contracture sinhala, bending of fingers, knots in the palm, inability to extend the fingers, dupuytren's disease sinhala, hand diseases, hand pain