Dupuytren's disease
| Dupuytren's contracture | |
|---|---|
| Synonyms | Dupuytren's disease, Viking disease, contraction of palmar fascia, palmar fascial fibromatosis, palmar fibromas |
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| Dupuytren's contracture of the ring finger | |
| Specialty | Rheumatology |
| Symptoms | One or more fingers permanently bent in a flexed position, hard nodule just under the skin of the palm |
| Complications | Trouble preparing food or writing |
| Usual onset | Gradual onset in males over 50 |
| Causes | Unknown |
| Risk factors | Family history, alcoholism, smoking, thyroid problems, liver disease, diabetes, epilepsy |
| Diagnostic method | Based on symptoms |
| Treatment | Steroid injections, clostridial collagenase injections, surgery |
| Frequency | ~5% (US) |
| Classification | |
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| External resources |
Dupuytren's contracture is a condition in which one or more fingers become permanently bent in a flexed position. It usually begins as small hard nodules just under the skin of the palm. It then worsens over time until the fingers can no longer be straightened. While typically not painful some aching or itching maybe present. The ring finger followed by the little and middle fingers are most commonly affected. It can interfere with preparing food, writing, and other activities.
The cause is unknown. Risk factors include family history, alcoholism, smoking, thyroid problems, liver disease, diabetes, previous hand trauma, and epilepsy. The underlying mechanism involves the formation of abnormal connective tissue within the palmar fascia. Diagnosis is usually based on symptoms.
Initial treatment is typically with steroid injections into the affect area and physical therapy. Among those who worsen clostridial collagenase injections or surgery may be tried. Evidence for radiation therapy, well used, is poor. The condition, however, may recur despite treatment.
Dupuytren's most often occurs in males over the age of 50. It mostly affects white people and is rare among Asians and Africans. In the United States about 5% of people are affected at some point in time, while in Norway about 30% of men over 60 years old have the condition. In the United Kingdom, about 20% of people over 65 have some form of the disease. It is named after Guillaume Dupuytren who first described the underlying mechanism in 1833.
Typically, Dupuytren's contracture first presents as a thickening or nodule in the palm, which initially can be with or without pain. Later in the disease process, there is increasing painless loss of range of motion of the affected fingers. The earliest sign of a contracture is a triangular “puckering” of the skin of the palm as it passes over the flexor tendon just before the flexor crease of the finger, at the metacarpophalangeal (MCP) joint. Generally, the cords or contractures are painless, but, rarely, tenosynovitis can occur and produce pain. The most common finger to be affected is the ring finger; the thumb and index finger are much less often affected. The disease begins in the palm and moves towards the fingers, with the metacarpophalangeal (MCP) joints affected before the proximal interphalangeal (PIP) joints.
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Wikipedia