A Family Doctor's Tale - DUPUYTREN'S CONTRACTURE

DOC I HAVE DUPUYTREN'S CONTRACTURE

DUPUYTREN'S CONTRACTURE is the PROGRESSIVE FIBROSIS OF THE PALMA FASCIA LEADING TO PAINLESS contractures of one or mor finger at metacarpophayngeal joints.
At least one or more fingers will be flexed against the palm.

DUPUYTREN'S CONTRACTURE occur as a result of proliferation and thickening of the connective tissues of the palmar fascia.
Nodules of irregular fibroblasts are formed.
Contraction of proliferated fibrous tissues leads to the deformity.

It is inherited as a Mendelian dominant in some cases.
It occurs predominently among Caucasians.
Men are affected 8 times more than women.

It has been associated with:

1.epilepsy

2.diabetes

3.alcoholism

4.as a late result of post myocasrdial infarction shoulder hand syndrome

Symptoms:
The onset is usually gradual with a wide spectrum of manifestations from simple contracture alone to plantar fascial involvement in the foot.

1.minimal flexion deformity in the early stages

2.palmar fascia can be seen puckering the skin

3.thickened or nodular underlying tissue can be felt

4.on or all fingers of either or both hands may be affected especially the ring and little fingers

5.Affected fingers are partly or completely held in fixed flexion and cannot be extended.

Treatment:
1.In mild cases no treatment is required

2.Corticosteroid injection to reduce inflammation at the thickened or nodular underlying tissues may help some patients

3.Surgery may be necessary as last resort to release the palmar fascia by cutting the tightened fascia

Complication:
If left untreated. it can lead to the permanent loss of the hand

Prognosis :
1.usually good with injection of corticosteroid

2.recurrence may occur after injection in which case surgery should be done

3.Amputation may be considered if the affected fingers interferes with activities of the hand