Dupuytren

Dupuytren's Contracture

Dupuytren's Contracture is a medical condition that affects the hands and fingers, leading to the progressive thickening and shortening of the palmar fascia. This condition results in the fingers being pulled into a bent position, which can impair hand function.

History

The condition is named after Guillaume Dupuytren, a French surgeon who described the surgical correction of the condition in the early 19th century. However, the condition was recognized long before Dupuytren's time, with descriptions dating back to the 17th century.

Epidemiology

Dupuytren's Contracture is more common in men than women and typically occurs in individuals over the age of 50. It is most prevalent in people of Northern European descent, leading to its nickname, "Viking disease."

Pathophysiology

The exact cause of Dupuytren's Contracture is not fully understood, but it is believed to involve a combination of genetic and environmental factors. The condition is characterized by the formation of nodules and cords in the palmar fascia, which gradually thicken and contract over time. This process is thought to be due to an abnormal proliferation of fibroblasts and the deposition of type III collagen.

Clinical Presentation

Patients with Dupuytren's Contracture typically present with:

• Nodules in the palm, often near the base of the ring and little fingers.
• Cords that extend from the palm into the fingers, causing them to bend towards the palm.
• Difficulty in extending the affected fingers, leading to impaired hand function.

Diagnosis

Diagnosis of Dupuytren's Contracture is primarily clinical, based on the characteristic appearance of the hand. Imaging studies are generally not required but may be used in atypical cases.

Treatment

Treatment options for Dupuytren's Contracture include:

• Observation: In mild cases, where hand function is not significantly impaired, observation may be appropriate.
• Needle Aponeurotomy: A minimally invasive procedure where a needle is used to divide the cords.
• Collagenase Injection: An enzyme injection that helps dissolve the cords.
• Surgical Fasciectomy: Removal of the affected fascia, typically reserved for severe cases.

Prognosis

The prognosis for Dupuytren's Contracture varies. While treatment can improve hand function, the condition may recur over time. Early intervention can help prevent significant disability.

Also see

• Palmar Fascia
• Fibroblast
• Collagen
• Hand Surgery