Dr. Gupta presently designated as the head of hand and shoulder department at Max Healthcare asserts that, “Dupuytren’s disease or contracture is a deformity in the hand that gradually develops over a period of years. It affects the tissue that lies beneath the skin of the palm such that chords or bumps develop on the patient’s palm and straightening his fingers or everyday activities such as shaking hands, putting on a pair of gloves or putting hands in your pocket also become unmanageable. As per my observation the disease mostly affects the ring and the pinky finger with men being more vulnerable to this disease in comparison to women.”
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An MBBS and MS in Orthopedics from AIIMS Dr. Gupta having fervently served innumerable patients for the last 25 years and skillfully performing more than 18000 surgeries vocalizes his perceptions about dupuytren’s disease, “This disease progresses very slowly and its first sign is the thickening of the palm skin. The patient thereafter develops these sensitive to touch but more or less painless lumps on his palm that gradually give way to formation of thick cord like structures that extend to the fingers. Now, these chords become a pulley for the fingers and as they tighten they pull the fingers in towards the palm. Mostly this disease affects both the hands but one of them gets affected severely than the other.
With apprehensions he states, “In terms of medical ascertainment we still haven’t been able to find any viable or conclusive reason as to why this disease develops. Though we believe that there are various reasons such as a person’s age being above 50, person suffering from diabetes, person habitual of alcohol and tobacco consumption, someone whose family member has had the disease in the past or a person who belongs to Northern European ancestry is more likely to be affected by Dupuytren’s contracture.”
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“Lastly I would like to assert that even though this disease takes a number of years to progress it should not be left untreated once diagnosed. There are no ways to cure or stop it except treatment by fasciotomy. The type of fasciotomy depends on the severity of the disease. But yes, the treatment does restore mobility in the fingers and with proper rehabilitation program the patient recovers almost all his functions and strength in the hands” winds up Dr. Gupta on Dupuytren’s contracture.
FAQ – Dupuytren’s Contracture /Disease
When the fibrous tissue just beneath the skin on the palm and fingers abnormally thicken causing bumps or chords on them and making the fingers flex towards the palm, it is referred to as Dupuytren’s contracture or Dupuytren’s disease.
The cause of Dupuytren’s disease is yet unknown. It is not an occurrence of heavy use of the hand or an injury but there are certain risk factors that increase the probability of its presence. These factors are-
- It is a hereditary disease
- It may be induced by too much intake of alcohol
- Medical problems such as diabetes and seizures may increase the risk of being affected by this disease
- Ageing is another factor that increases its probability
- People with Northern European or
- Scandinavian ancestry are most likely to be affected by this disease
Not very painful the disease gets noticed only after a few years as it progresses very slowly. The signs that mark its presence are-
- Painless but tender to touch small lumps in the palm
- Tough bands or cords on the palm under the skin
- Fingers bent towards the palm prevalently the little and the ring finger
To clinically diagnose the disease the initial assessment begins with the examination of the hand to testing the sensations feelings felt in thumb and fingers by ascertaining their grip strength. Rarely any other tests are required for it. While examining the hand, the bands and nodules locations on the palm are recorded and with a special device the contractures in the fingers are also measured. The hand of the patient is kept flat on a table to observe the position of the fingers. If the patient is unable to keep the fingers flat on the table it is deduced that the patient is suffering from Dupuytren’s contracture.
As the disease progresses it might cause grave problems in the use of hand and fingers for certain functions such as opening hand fully, grasping things, trying to put hand in narrow places or inside the pocket. It is essential that the condition be taken up by effective treatment else the hand and fingers may forever become clinically inactive.
Once the disease starts to progress there is no way to stop it or cure it. Mild cases are treated with non- surgical techniques or a technique called needle fasciotomy whereas severe cases are taken up for treatment by open fasciotomy and fasciectomy. Non surgical techniques include radiation therapy or injections of medicine collagenase clostridium histolyticum. The technique ‘needle fasciotomy’ is a technique performed on an outpatient basis where a needle or blade is used to divide the chords under the skin of the palm after numbing the hand with local anesthesia. Open fasciotomy is also an outpatient technique but is taken up for more severe cases. Under this technique the patient is given local anesthesia to numb the hand and the hand surgeon makes small incisions to cut the chords that are hindering the finger movements. After surgery the cuts are stitched back and the healing time for this type of surgery is more than needle fasciotomy. The last technique is referred to as Fasciectomy under which the connective tissues that have thickened are removed. It is generally carried out in one of the three ways- regional, segmental or dermo fasciectomy. The cuts made on the skin to remove the tissues are longer and are sealed back by skin grafts.
Complications after surgery are rare though the risks may include an injury to the blood or nerve vessels during surgical intervention, infection in the surgical cut or persistence of stiffness even after surgery.
It may take long to restore full or partial movement in the hand and fingers. Apart from mild soreness and swelling surgery is usually successful in restoring finger movement but with the essential implementation of physical therapy and occupational therapy to restore strength in the hand and fingers as well as help the patient to cope with everyday activities at home and at work. Though 20% patients are found to be affected with recurrence of the condition averagely the surgical repair is highly affluent. The severity of the disease and the procedure taken up more or less decide how long will it be before normal activities can be resumed. Driving may usually be resumed after three works and as regards work activities light office work may be picked up after a few days of the surgery but heavy work is only recommended after a period of six weeks or so.
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- Dupuytren’s Contracture /Disease