Dupuytren's Contracture

Dupuytren's contracture (or Dupuytren's disease) is a fixed flexion contracture  of the hand due to thickening of some of the tissues in the hand resulting in the fingers bending towards the palm and cannot be fully extended (straightened). It is an inherited proliferative connective tissue disorder that involves the hand's palmar fascia (layer of tissue within the palm of the hand)

The ring and little are the fingers most commonly affected. Dupuytren's contracture progresses slowly and is often accompanied by some aching and itching. In patients with this condition, the palmar fascia thickens and shortens so that the tendons connected to the fingers cannot move freely.  The incidence of Dupuytren's contracture increases after age 40; at this age, men are affected more often than women. Beyond 80 the gender distribution is about even

Symptoms

Dupuytren's contracture decreases patients' ability to hold objects. Patients often report pain, aching and itching. Dupuytren's disease often starts with nodules in the palm of the hand and it can extend to cause a contracture in a finger.

Risk Factors

Dupuytren's contracture is a non-specific affliction, but primarily affects:

People of Scandanavian or Northern European ancestry, it has been called the "Viking disease" or "Celtic hand", though it is also widespread in some Mediterranean countries (e.g., Spain and Bosnia) and in Japan.

Men rather than women (men are ten times as likely to develop the condition).

People over the age of 40

People with a family history (60% to 70% of those afflicted have a genetic predisposition to Dupuytren's contracture).

Causes

The cause of Dupuytren's contracture is unproven but suspected to include trauma, diabetes, alcoholism, epilepsy therapy with phenytoin, and liver disease. No proven evidence links hand injuries or specific occupational exposures to a higher risk of developing Dupuytren’s. Some speculation links the condition or its onset may be triggered by, physical trauma such as sustained manual labor or over-exertion of the hands.

Assessment

A full assessment of your affected hand and suitability for treatment will be performed by Mr Stanley Loo at either East Care Specialist Centre or Ormiston Specialist Centre prior to any treatment.

Treatment is indicated when the so-called table top test is positive. With this test, the patient places his hand on a table. If the hand lies completely flat on the table, the test is considered negative. If the hand cannot be placed completely flat on the table, leaving a space between the table and a part of the hand as big as the diameter of a ballpoint pen the test is considered positive and surgery or other treatment may be indicated. Additionally, finger joints may become fixed and rigid.

Treatment

Surgery is currently the mainstay of treatment for symptomatic Dupuytren's contracture (however their is currently a worldwide trial with collagenase although this is still considered experimental at this stage).

Surgery involves either a general anaesthetic or regional block and involves excising all of the thickened tissue which includes the palmar fascia and may include the overlying skin but retaining the important neurovascular structures within the hand and fingeers. The joints can also be involved in the more severe cases and all attempts are made to improve the function of the joints.

The reconstruction of the resulting wound is performed using either a skin lengthening procedure or with a skin graft.

The length of time for the procedure is dependent on the severity and number of the contractures involved in the hand. Mr Stanley Loo usually performs this procedure on one hand at a time.

Post Operative Care

After your procedure your operated hand will be in a splint and a sling for approximately 1- 2 weeks depending on the type of reconstruction performed.

You will be followed up by Mr Stanley Loo to ensure that everything is healing as it should and also referred to a hand therapist for hand therapy and a custom made splint which needs to be worn for up to 3 months.

If you would like further information regarding the correction of Dupuytren's contracture, an appointment can be made with Mr Stanley Loo at Eastcare Medical specialist Centre, 260 Botany Rd, Howick, Auckland. Ph. (09) 277 1540 or Ormiston Specialist Centre, 125 Ormiston Rd, Flat Bush, Auckland, Ph (09) 271 3305