Dupuytren’s Contracture (DC), A Hand Disorder– Its History and Treatment

Dupuytren’s contracture (DC) is a condition consisting of a shortening and thickening of the palm’s tissue which results in clawing of the fingers. Its cause is unknown, but  is thought to be hereditary. Other causal factors may include advancing age and  conditions, such as diabetes, alcoholism  and epilepsy. Treatment may include a range of therapies, surgery and exercises.
The hand palm  contains a  layer of tissue called the palmar fascia, which reaches across the palm to the fingers. DC is a thickening and shortening of this web of fascia that gradually can cause clawing of the fingers because they are pulled towards the palm. Any finger can be affected but the ring and little finger are usually affected.
DC tends to progress in an on and off method, and may take years to finally limit the functioning of the hand. The  cause of the disease is unknown, but it usually occurs among certain groups which include:
DC can sometimes run in families,  suggesting a genetic component. The type of treatment depends on the severity of the condition, but could include injections of corticosteroids into the hand and surgery.
Features of DC include:
A lump or nodule  on the palm, which usually appears close to the bottom of the ring or little finger.
There is what appears to be a thickened cord  along the palm to the fingers.
In time,  the fingers become clawed because they are pulled towards the palm.
The hand bows, the fingers are  pulled against the palm and the skin of the palm is dimpled and puckered..
There is rarely any associated pain.
Contributing factors to the  exact trigger are unknown. However, they may include:
Heredity – the condition tends to occur in families.
Ancestry –  Celtics or Scandinavians  are at  an increased risk.
Age – the condition occurs more  in middle to later years of life.
Gender – almost 10 times more men than women are affected.
Alcoholism – the contracture seems to be more severe in alcoholics.
Certain medical conditions – people who have diabetes and epilepsy have a higher incidence of DC.
Although in most cases, only the hands are affected other associated difficulties can include:
Garrod’s pads – the  joints of the finger on the same hand may enlarge and become thick.
Peyronie’s disease – there may be thickening and shortening of penis tissue .
Ledderhose disease – creates thickening and shortening  of deep connective tissue on the foot. As the disease progresses, this can cause  severe pain while walking.
The type of treatment depends on the severity of the condition. In its initial stages, treatment may include injections of corticosteroids into the fascia. These medications can reduce  localised tenderness and may  delay subsequent thickening of the tissue.
Other treatments include calcium channel blockers,  percutaneous needle fasciotomy and treatment with gamma-interferon.
If as in severe  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 may be indicated. DC can sometimes return after surgery, either at the same place or somewhere else on the palm.
The surgery options may include:
Cutting the fascia bands through small incisions in the palm
Removing the fascia and associated skin, and using a skin graft to seal the palm
Amputation of an affected finger, if the problem has returned so many times that corrective surgery is no longer a viable alternative.
Occupational therapy is necessary after surgery in order to speed recovery and reduce any risks of the contracture returning.
Specific techniques may include:
A splint worn during daytime.
A splint worn at night for several months in order to straighten the finger
Special hand exercises to encourage flexibility
Massage with moisturising hand cream.
When exercising the hand is indicated the use of the HANDTUTOR will afford excellent intensive exercises for the patient. The HANDTUTOR is a safe comfortable ergonomically designed glove containing position and speed sensors that precisely record finger and wrist motion. Rehabilitation games allow the patient to exercise range of motion, speed and accuracy of movement including opposition and pinch movement practice.
Currently in use in leading U.S. and European hospitals and clinics the HANDTUTOR and its sister devices (ARMTUTOR, LEGTUTOR, 3DTUTOR) are fully certified by the FDA and CE. They are available for adults as well as children from the age of 5 and up and can be used at home through telerehabilitationDC.
See WWW.MEDITOUCH.CO.IL for further information.
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