Dupuytren's contracture is a relatively common genetically inherited disorder of the fingers of the hand that can affect one or even both hands.
Medically, Dupuytren's contracture (attached finger) is defined as a proliferative fibroplasia of the fascia covering the muscles and tendons of the hand. The palmar fascia cells are altered, their exfoliation occurs and the overall elasticity of the fascia is reduced.
The disease is characterised by nodules and formations which may lead to secondary lesions such as progressive irreversible finger joint contractures. The subcutaneous fat begins to adhere to the skin of the palm, pulling it deeper. As the skin is stretched, the fingers are flexed.
Symptoms
- Pain does not usually occur;
- Constantly bent fingers and fingers pressed against the palm of the hand cause discomfort at work or in everyday activities;
- Difficulty extending the fourth and fifth fingers;
- Wrinkling of the skin on the palm and palmar side of the fingers;
- Palpation of the palm of the hand may reveal painless nodules;
- At the beginning of the deformity, there may be stretching and tingling of the suture and resistance when trying to extend the fingers.
Stages
Dupuytren's contracture progresses through several stages: proliferative, involutional and residual.
In the proliferative stage, nodules composed of type III collagen fibres and fibroblasts appear and expand through the subcutaneous tissue and grow into the skin. Nodules usually arise at the distal (far) crease of the palm, at the metacarpophalangeal joints (MCP) and more distally through the proximal (near) intercarpal joints (PIP), but not the distal intercarpal joints (DIP).
The nodules stop growing and start forming in the involutional (reversible, reduction) phase of the contracture . Fibroblasts start to increase, stimulating more collagen production. Myofibroblasts (cells with contractile properties) replace and dominate the fibroblasts, leading to an increase in type III collagen production and, as a consequence, tissue contraction. The contraction of the nodules leads to stretching of the palmar fascia in the proximal direction, i.e. towards the wrist, causing hypertrophy (enlargement) of the palmar fascia and the formation of nodular trunks that spread towards the fingers. One or more fingers become flexed and cannot be extended.
In the residual stage, the nodules shrink and may become non-cellular fibrotic fibres.
Treatment
Dupuytren's contracture is treated only surgically. During surgery, incisions are made in the structure of the affected finger to release the stretched tissues. Opening the skin of the palm and finger reveals pathological protrusions of the palmar fascia, which are corrected by removing them. This not only restores the normal function of the palmar fascia, but also restores the range of movement of the affected fingers.
In order to fully regain the lost function of the fingers, it is necessary to carry out physiotherapy and occupational therapy exercises. Full hand function is regained approximately 4 weeks after surgery and all rehabilitation procedures.
Sources:
1. https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323374620000756
