Have you ever felt like the skin on your palm has thickened and formed small bumps? Or that you have difficulty keeping one or two fingers straight, and they gradually bend towards the palm? This is not unique to you. This is a medical condition. We call it Dupuytren's Contracture. Many people don't know much about this, so it can be scary. So today we will talk about everything very simply and in a friendly way.
Simply put, what is Dupuytren's Contracture?
This happens because a layer of tissue (fascia) under the skin of your hand gradually thickens and forms fibrous cords. It's like someone is pulling a rope from inside your hand. Over time, as these cords tighten, one or more of the fingers that are connected to them start to bend inward. This is what we call a `contracture`. This condition most commonly affects the ring and little fingers, but it can happen to any finger.
This is not cancer or an infectious disease. And the pain from it is usually minimal. But the main problem is that when the fingers are bent, it becomes difficult to perform everyday tasks. For example, even simple things like shaking hands, reaching into your pocket, or gripping something tightly can be a challenge.
How is treatment decided?
Treatment for Dupuytren's contracture varies depending on the severity of your condition. There is no one-size-fits-all treatment. Your doctor will examine you and determine the best treatment based on how much it is affecting your life.
The most important thing is that no treatment found so far can completely stop the development of this disease or prevent it from getting worse once it has developed. The main goal of treatment is to reduce symptoms and restore function in the hand.
For some people, the condition progresses very slowly. It may just be a small lump on the palm of your hand that doesn't change for years. In such cases, if it doesn't interfere with your daily activities, it's best to take a "wait and see" approach.
However, if your finger flexion is rapidly increasing and making it difficult to perform daily tasks, your doctor will discuss appropriate treatment options for you.
Nonsurgical Treatments
There are several treatments that can be used in the early stages of the disease, or in addition to surgery. However, these have only shown limited success.
| Treatment method | What happens to it? |
|---|---|
| Stretching | It is recommended for those with very mild disease. It can also be used in conjunction with other treatments. However, these should be done only as directed by the doctor . |
| Steroid Injections | These are powerful anti-inflammatory drugs. When injected directly into a nodule on the arm, it can reduce its size. However, this is only effective in the early stages of the disease. Once the tissue has thickened, it is not very effective. |
| Enzyme Injections | If your finger is already bent, your doctor may recommend an injection of an enzyme mixture, such as Xiaflex . These enzymes break down the thickened tissue and loosen it. The next day, your doctor will try to straighten your finger by holding it and pulling it. This can be used as an alternative to surgery. |
| Radiation Therapy | Low-level radiation therapy is another option, but there is still limited research data on its success. |
A little more about enzyme injections...
For most people, one or two injections are enough for the affected joint. Some people may need up to three. The most common side effects are swelling, bleeding, bruising, and pain at the injection site. Very rarely, serious side effects such as tendon damage, nerve damage, or allergic reactions can occur.
Other treatments such as splinting, vitamin E cream, and ultrasound have been tried, but they have not generally yielded successful results.
When is surgery necessary? (Surgical Treatments)
If you are having difficulty performing everyday tasks, such as gripping something, writing, or holding a cup, your doctor may recommend surgery. The main goal of surgery is to restore the lost movement in your fingers.
There are two main types of surgery.
| Type of surgery | Description |
|---|---|
| Open Surgery | The surgeon makes an incision in the arm and cuts the thickened tissue (fasciotomy) or removes all or part of it (fasciectomy) . Sometimes a skin graft is used to close the wound. |
| Needle Aponeurotomy | This is a simpler procedure than open surgery. The surgeon uses a hypodermic needle to cut and separate the thickened tissue above the skin. The recovery time is shorter. Most people do not need physical therapy afterward. |
What to expect after surgery?
Surgery can often correct the bending of the fingers and restore the function of the hand. However, if several fingers are bent, it can be a little more difficult to correct.
Surgeries also have some risks and complications.
- Recurrence: There is a certain risk of recurrence with both types of surgery.
- Other complications:
- Wound swelling and pain
- Damage to nerves or blood vessels
- Infections
- Tissue death
How to recover quickly?
It is very important to follow your doctor's instructions exactly after surgery.
- Elevate your arm: Elevating your arm above your heart can help reduce swelling and pain.
- Finger wiggles: If the doctor instructs you, wiggle your fingers.
- Physical therapy: Your doctor may refer you to a physical therapist . He/she will teach you exercises to improve your hand strength and function.
Take-Home Message
- Dupuytren's Contracture is a condition in which the tissues in the hand become thickened and the fingers bend. It is not a cancer or contagious disease.
- Not everyone needs surgery. If the disease is mild, it may not require any treatment.
- If this is interfering with your daily activities, there are non-surgical (injections) and surgical treatment options.
- Only your doctor can determine the best treatment for you. So if you notice any changes in your hand, don't be afraid to seek medical advice.
- After treatment, follow the instructions given by your doctor and physical therapist carefully for a speedy recovery.
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