|"Contracture cord leading to the ring finger"|
under the theme
Clinical Pictures in
Carpal Tunnel Syndrome
de Quervain's Tendinitis
|"Exposed contracture cord"|
|"After removal of contracture tissue"|
|"Suture after operation"|
|Definition of Dupuytren's Contracture:
Dupuytren's contracture involves the scar-like, thread-shaped, taut shortening of the so-called palmar aponeurosis. The palmar aponeurosis is a triangle-shaped plate of connective tissue located under the skin of the palm. This type of tissue is also present in the rest of the body where it covers the musculature and other structures with a considerably thinner 'skin' (fascia). This fascia (aponeurosis) is thickened like a plate in the palm and on the foot sole even under normal conditions (Illustration 1).
The Dupuytren's contracture disease was first described in 1831 by Baron Guillaume Dupuytren, a famous French surgeon. Due to nodule and cord formation between the palm and the finger, scar-like tension of the palmar aponeurosis can lead to the contracture (bending) of one or more fingers (Illustration 2).
The severity of functional limitation depends more or less on the degree of contracture
Cause of Dupuytren's Contracture
The cause of Dupuytren's is unknown. It is likely that this disease arises along with other diseases of the connective tissue. A relationship with liver disease, Diabetes mellitus and alcoholism has been discussed but not proven. Genetic predisposition definitely exists as the disease often affects multiple family members. Dupuytren's contracture affects men approximately eight times more often than women and usually manifests itself between the ages of 40 and 60.
Injury is not recognized as the cause of the onset of the disease and cases where the disease emerges after injury are seen as coincidental. The hand sustains multiple minor and major injuries during our lifetimes, so that cases with a causal relationship with Dupuytren's contracture must arise significantly more often.
Signs and Symptoms of Dupuytren's Contracture
The first sign is typically the formation of nodules in the palm of the hand, usually in the area under the ring and little fingers and less often in the area of the other three fingers. However, the first sign can also occur as nodules directly on the fingers in some cases.
Contracture of the skin in the area of the palm can also exist. This occurs when the fibers that radiate out from palmar aponeurosis and into the fingers contract.
Dupuytren's cords usually run lengthwise from the palm to the fingers, rarely diagonally, and sometimes reach over the entire finger. (Illustration 3).
These cords cause the fingers to contract in towards the palm.
The advancement of Dupuytren's contracture can occur at various rates and sometimes comes to a complete standstill for longer periods of time.
However, degeneration of existing contracture is not to be expected.
Even when the contracture only affects one or two fingers, this can still lead to a severe limitation of the functionality of the hand.
Idiosyncrasies of Dupuytren's Contracture
Diagnosis of Dupuytren's Contracture
The typical clinical appearance secures the diagnosis. False diagnosis is almost impossible. In rare cases, other tumors (epithelial cysts) can mimic Dupuytren nodules.
Treatment of Dupuytren's Contracture:
There are various possibilities for ensuring that the patient is free of pain during the surgery. These possibilities will be explained to you by the anesthesiologist.
Technical Aspects of the Surgery
Surgery for Dupuytren's contracture is usually out-patient, that is, the patient can go home once the operation is completed.
1. General surgical preparation:
Even after returning to work and the completion of physical and occupational therapy, the patient must continue learned exercises for weeks or months in order to prevent scar-related contracture. The prescribed flexor splint should continue to be worn for several more weeks until no change in the scar area is noticed.
Scar discomfort largely disappears after the first 6-8 weeks. After 3-6 months patients no longer complain of pain. However, the scars final state is not reached until approximately 12 months after surgery.
© Dr. Klaus Lowka
back to top
|Home | About Dr. Lowka | Advanced Education/Publications | The Hand
Hand Surgery Diagnosis and Operations | Clinical Pictures in Hand Surgery | Areas of Emphasis in Hand Surgery
Post-operative Treatment | Center for Diagnosis and Out-patient Surgery
Contact Us | Legal Information