Is there a way to prevent Dupuytren contracture?
Two ways to look at Dupuytren prevention
In Dupuytren contracture the soft tissue (fascia) beneath skin of the palm, usually near the 4th and 5th digit, becomes thickened and shortened. During progression of the disease shortened nodules and Dupuytren cords of collagen eventually cause the affected fingers to lowly pull down permanently toward the palm.
The cause of Dupuytren contracture remains unknown, but is primarily considered a genetic disorder that can be triggered by a variety of external factors. With the genetic component in mind, it might be more realistic to think in terms of delay of onset or slowing of progression of the Dupuytren problem, rather than prevention. However, if one is skillful enough at avoidance of those known triggering mechanisms delay could be prolonged so well into the future that a potential hand contracture never develops. Nonetheless, there are two ways to consider prevention of this disabling hand condition.
Dupuytren genetic predisposition
The most common opinion is that there is no way to prevent Dupuytrens because it is essentially an inherited or genetic condition passed down from parents to children, primarily affecting those of Scandinavian or northern European (U.K.) descent. In Norway close to 30% of people over age 60 display Dupuytren hand disease, with males three times more likely than females to be in this group. Inconclusive research has placed the dominant gene for Dupuytren contracture at chromosome 16q, although this has not been confirmed.
This apparently inherited susceptibility may increase the palmar fascia’s sensitivity to the cumulative effects of environmental exposure (trauma, liver disease, diabetes, etc.). Non-genetic causes of Dupuytren contracture are explained as eventually overwhelming the genetically weakened tissue due to intense and prolonged exposure.
Solely as a genetic disorder, Dupuytren prevention is not possible at this time. But from the standpoint of the environmental factors there is much a person can do to reduce the chance of developing a hand lump and subsequent contracture.
Avoidance of exciting factors
A second opinion about prevention of Dupuytren’s contracture is that avoidance of known precipitating biochemical stressors is a workable strategy, if not simply to delay its onset. As mentioned above, trauma, liver disease, diabetes, cigarette smoking, etc., have been statistically linked to Dupuytren contracture for people who are genetically predisposed. In these examples, purposeful avoidance decisions are a way to prevent the triggering of the genetic predisposition:
- Trauma – avoid work/hobby activities that might injure hands; use shock absorbing gloves it vibration of hands is unavoidable
- Liver disease; liver cirrhosis – do not drink alcohol, or at least keep consumption modest; avoid drug use whenever and however possible; be mindful of environmental toxin exposure (pesticides, cleaning chemicals)
- Diabetes – reduce refined sugar intake; increase complex carbohydrate intake; supplement diet with chromium and B6 to enhance carbohydrate metabolism
- Pulmonary disease – stop cigarette smoking and avoid second-hand smoke; attempt work and hobby activities in a clean air environment
Limiting exposure to known predisposing situations is an elemental Dupuytren prevention measure.
Prevention of Dupuytren contracture with at-home measures
Certain home treatments and stretching exercise for Dupuytren contracture of the involved fingers can restore a variable degree of hand mobility, depending on unique factors of each case, and as such can be considered important to prevention of Dupuytren advancement. Daily Dupuytren stretching and massage is especially important if hand surgery has been done. Twice-daily sessions of deep massage to the tissue immediately adjacent to the known nodule or contracture can be effective. Carefully and gently stretching the fingers as far back into comfortable extension is also a good strategy, but it is essential to not be aggressive when doing this work. Over time this can relieve tightness in the deep palmar tissue to maintain finer flexibility.
Recurrence of Dupuytren contracture occurs after hand surgery in a high percent of cases. Splints are used for eight to 10 weeks after surgery to help to restore hand function and prevent Dupuytren’s disease from recurring as quickly as it would otherwise. By supporting the fascia of the palm and keeping the affected finger(s) straight at night during post-op healing, hand splints go a long way to assist recovery and prevent Dupuytren recurrence.