Dupuytren contracture of hand explained
Dupuytren’s disease is a hand contracture (also known as Dupuytren contracture, palmar fibrmatosis and morbus Dupuytren and occasionally misidentified as Dupuytren’s constriction). It is a slowly developing fixed flexion contracture of the hand caused by thickening and shortening of a thin layer of connective tissue on the palm of the hand called fascia. In this hand contracture one or more fingers of one or both hands bend toward the palm and eventually cannot be fully straightened. The connective tissue under the skin of the palm becomes thick and irregular appearing, and eventually shortens so that the tendons of the involved fingers cannot move freely.
Technically, the palmar aponeurosis (a large layer of interconnected tissue) becomes dense and thick as the cells of the area increase in number, resulting in a thickening and inelasticity, and contraction.
In Dupuytren hand contracture the little finger and ring finger are most often affected. The middle finger may be occasionally included only in advanced cases, while the thumb and index finger are rarely included.
Dupuytren contracture usually progresses slowly, especially for women, although the individual might think that progression is otherwise. When present in both hands, and when there is associated foot involvement (Ledderhose disease) or penile shaft (Peyronie’s disease), the hand contractures tends to progress more rapidly.
It is usually painless for the most part, although for many it begins as a “tender lump” on the palm of the hand. In the early stages some mild to moderate pain might occur on an irregular basis; as the hand contracture progresses, pain is reduced over time in intensity and frequency.
The incidence of Dupuytren hand contracture increases after the age of 40. Between the ages of 40 and 60 years, men are affected more often than women. After 60 years of age women begin to gain in development of Dupuytren, until age 80 when the incidence is approximately equal.
Hand contracture risk factors, possible causes
Hand contracture non-specific cause that primarily affects:
- • People of Northern European (UK) and Scandinavian descent, hence the name “Viking disease” is sometimes used. This does not spare people from other parts of the world who can also be affected; it is very common in some countries (Spain, Bosnia and Japan).
- • Men rather than women (men are ten times as likely to develop the condition) are more likely to develop hand contracture between ages 40-65.
- • Those who engage in frequent micro-trauma to the tendons of the hands (carpenters, rock climbers, brick layers, factory workers) are more likely to develop hand contractures.
- • People in general over the age of 40
- • Sixty to 70% of those with a family history of hand contracture have a genetic predisposition
- • People with liver cirrhosis associated with heavy alcohol intake, epilepsy, and diabetes
While trauma is an unproven risk factor for Dupuytren hand contracture, there is no statistical evidence that a history of hand injury or a specific occupation category puts a person at higher risk of developing Dupuytren contracture. The fact that Dupuytren hand contracture is not connected with handedness casts places trauma as a doubtful cause.