What is the difference between Dupuytren syndrome and Dupuytren contracture?

Dupuytren Syndrome

What is the difference between Dupuytren contracture and Dupuytren syndrome?

Occasionally the term Dupuytren syndrome appears when researching the subject of Dupuytren contracture.   It might appear to those who do not know the actual meaning of the term syndrome that a Dupuytren syndrome might be something different – perhaps less serious or more serious – than the more conventional terms of Dupuytren contracture or Dupuytren disease.

A good place to start is with a discussion of these different words.

Syndrome – generally, a collection or group of signs (objective findings that are observed by someone else) and symptoms (subjective complaints that are felt or experienced that cannot be proven by the person who is feeling them) that are known to commonly appear together, but without a known cause to explain their occurrence.

Sometimes the word syndrome is applied to a condition or disorder when there is strong agreement about a cause, when there are multiple alternative or contributing factors that it is not possible to isolate the cause to one single factor.  This is true of Dupuytren contracture since it is commonly agreed that there is a strong genetic cause of the condition there are also several contributing and overlapping issues that cloud the causation of the problem (liver cirrhosis, diabetes, trauma, lung disease, etc.)

Because of the way the word syndrome is used, laypeople might get the impression that a syndrome is something less serious than a disease or that it is a made-up or imagined problem.  That is not the case.  The last part of the definition explains that the most important point is that a syndrome will not have a known cause or reason to explain the problem.

Some examples:  Carpal tunnel syndrome, Gulf War syndrome, Premenstrual syndrome, Reye’s syndrome, Down’s syndrome, etc.

Disease – a health disorder in a system, organ or part of the body that adversely affects the body’s function, and fulfills at least two of the following criteria:

    1. Known group of signs and symptoms
    2. Known and identified cause
    3. Consistent anatomic or physiologic changes due to the disease

In regard to Dupuytren contracture is simple to see that the term Dupuytren disease is accurate since it does fulfill all of the definition requirements.

Contracture – a chronic and unrelenting state of tightening or shortening of muscle, tendon, ligament, or skin that prevents a normal range of movement of the involved area.

Therefore, there is nothing wrong with the term Dupuytren syndrome, it is a legitimate term for this problem; the same can be said for the term Dupuytren disease.   All of these are legitimate terms to use.  However, on this website we have maintained the use of the term Dupuytren contracture as the preferred term because it is a more descriptive term that accurately defines the palmar and finger contracture as the central aspect of this hand condition.

>> Dupuytren Contracture Treatment – FAQs

>> How to start Dupuytren treatment with Alternative Medicine

>> Testimonials from Dupuytren Contracture Institute

 

If it is not Dupuytren contracture what else could keep my finger bent down?

Dupuytren Contracture and Similar Conditions

There are actually only a few different conditions that might be confused with Dupuytren contracture.

These are the primary hand conditions, other than Dupuytren contracture, that can prevent the finger from straightening out from a flexed position:

  1. Trigger finger – this is the sticking and sudden release of restricted flexor tendon in the sheath that also commonly as an associated aspect of  Dupuytren’s contracture
  2. Ulnar nerve injury – results in a “claw hand deformity” of the entire, due to lack of extensor muscle function
  3. Extensor tendon rupture – often associated with direct trauma or arthritis
  4. Subluxation or slipping of  extensor tendons between the knuckles associated with arthritis
  5. Ganglion cyst, or a soft-tissue mass – often presents as a small and movable nodule that is tender to palpation at the metacarpophalangeal (MCP) joint, and not as far back into the palm as Dupuytren usually is located; often seen in people younger than 50 years of age and without common risk factors for Dupuytren disease
  6. Post-traumatic or arthritic joint stiffness
  7. Sarcoma – biopsy will most likely reveal a benign etiology (e.g., lipoma, inclusion cyst).

>> Testimonials from Dupuytren Contracture Institute

>> Dupuytren surgery

The major differentiation sign between these listed conditions and Dupuytren contracture is that none of them is associated with the appearance of nodule or cord development on the palmar surface of the hand.  Based on this single point of differentiation the diagnosis of Dupuytren contracture is a fairly simple and straight forward matter.  However the diagnosis can be made more complex when the person with Dupuytren contracture also has present at the same time one or more of these other conditions.

Making the differentiation between Dupuytren contracture and other hand problems easier, the following points should be kept in mind:

  1. Typically the person with Dupuytren  disease is 50 years or older
  2. The likelihood of Dupuytren disease increases when a pitting or indentation is observed over the nodule(s) or alongside the cord(s)
  3. The likelihood of Dupuytren disease increases further when the nodule or cord formation is present bilaterally.

Early treatment of a Dupuytren contracture makes for a better outcome.  Learn more about using Alternative Medicine for Dupuytren treatment on the DCI website.

>> How to start Dupuytren treatment with Alternative Medicine

>> Dupuytren Contracture Treatment – FAQs

Is my other hand problem related to Dupuytren’s contracture?

I am a 56 year old female, nee Thomasson, with Nordic Viking ancestors having settled from Ireland on the Wirral Peninsula, Cheshire, England in 902. My father exhibited severe Dupuytrens, as did my grandfather, and my paternal aunt. I have the disease moderately advancing in my right (dominant) hand.

My question is: In my left hand, I have a “knuckle pad” on my pinkie finger, and experience occasional UBER SEVERE “catches” or “twinges” on my outer left palm.  This can occur suddenly, and without aggravation, e.g., opening a car door, tying a scarf.   The pain is debilitating. It feels as if I have “karate chopped” a brick wall. My outer palm feels tender and bruised.  I need help with simple tasks, e.g., fastening my bra, lifting a pot of oatmeal….The pain gradually subsides over 5-9 days, and I’m good as new ’till the next occurrence… This happens 3-4 times a year.

Related to Dupuytrens? Any idea what this is? I haven’t been able to find any other references. BTW, I also do have carpal tunnel syndrome in the dominant right hand (the Depuytrens Claw…) but control that thru acupuncture – Currently not an issue.

Many Thanks!

Deborah

 

Greetings Deborah,

You certainly fit the classic description for the genetic basis of Dupuytren’s contracture.

In severe Dupuytren disease there can be related soft tissue problems, especially with the tendon sheaths and nerves if there is significant anatomical compromise in this part of the body where so many delicate structures are so closely packed together – no room for error, you might say.  Your occasional and temporary  “uber severe” left hand episodes could be related to infrequent exacerbation caused by over work or slight unnoticed trauma that has disproportionate consequences.  If  there is an association between the two it could be of the strong indirect kind because of the possibility you are developing DC in the other hand as well.  

Have you considered trying to help yourself with natural Dupuytren treatment?    TRH

Is it a trigger finger or Dupuytrens contracture?

I have it bad in my hands, my fingers either draw in or lock up during use and pain is THERE … I also have lumps under my skin on my lower back, are these the same thing?

 

Greetings,

When you say you have “it bad’ in your hands, exactly what do you mean?   Do you mean that you have a problem of bad pain and finger locking?   I cannot assume that you actually have Dupuytren’s contracture unless you have formally been given a medical diagnosis.    Usually, finger locking and severe pain are not a prominent part of Dupuytren disease.   The way you describe that your  “fingers either draw in or lock up during use” makes it sound like it is an occasional event, and this is not true of Dupuytren because when your fingers are flexed with Dupuytrens they stay that way except to slowly worsen; they do not straighten beyond the point of their involuntary flexion deformity. 

What comes to mind is that you have a trigger finger in one or more fingers.  Please see this link for information comparing trigger finger and Dupuytren contracture.  

A soft lump under the skin of the lower or mid back is often lipoma.    If this is true for you needs to be determined by medical examination.    There is no association between lipomas and Dupuytren’s contracture. 

Please have a competent orthopedic doctor examine you to determine what is going on with your hand and back.   TRH           

 

 

 

What is the difference between needle aponeurotomy and palmar fasciectomy and what are the risks?

Needle aponeurotomy and palmar fasciectomy greatly different

Needle aponeurotomy and palmar fasciectomy are two completely different kinds of Dupuytren contracture surgery.  As with any kind of hand surgery done to release the contractures of Dupuytren disease, each has its own value, risks and limitations.  The risk and limitation of Dupuytren surgery should be considered not only because of the potential permanent consequences (numbness, reduced finger movement, reduced hand strength, reduced sensations and pain) that can occur, but also because hand surgery is not your only Dupuytren therapy option.

Alternative Medicine is a conservative and essentially risk free alternative that could make surgery unnecessary.

Dupuytren’s surgery, even when done well, can have bad unintended consequences as well as stimulate the recurrence of additional nodule and cord formation in the palm.  Since 2002 this website has suggested that anyone with Dupuytren contracture should first consider the conservative non-surgical and non-drug treatment options before attempting irreversible surgery.  To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment

What is a needle aponeurotomy?

Needle aponeurotomy, also called palmar fasciotomy, is considered minimally invasive Dupuytren hand surgery since a scalpel is not used to open the skin of the palm.

Needle aponeurotomy is performed by inserting a hypodermic needle into the palm of the hand with the intention to move the needle tip in a variety of directions to cut, tear and weaken the offending cords and contractures in the palm.  Without being able to see the collagen structures he is slashing with the needle tip, the surgeon blindly attempts to destabilize and release those same cords and fascial contractures that prevent full straightening of the involved fingers.

Because these structures cannot be seen as the needle moves, the risk is that nearby nerves, blood vessels and tendons might be accidentally injured or destroyed

What is a palmar fasciectomy?

There are several types or palmar fasciectomy, depending on how much tissue is removed during this type of hand surgery.  Let us begin with the words, palmar fasciectomy.

Palmar refers to the palm of the hand. Fasciectomy refers to a kind of surgery performed on fascia.  Fascia is the thin, white, tough layer of soft tissue that covers, surrounds and lines all organs, structures, tissues and cavities of the body. You can think of fascia like the clear plastic Saran wrap used to cover and protect food.  When you look in the meat case at the butcher shop you can see all kinds of fascia in the cheaper grades of roasts and steaks.   Because hands need extra support and protection from the heavy work they do, there is normally much fascia in the palm.

The ending “-ectomy” means that the surgery is done through an opening in the skin and something is removed – in this case fascia.   So, a palmar fasciectomy is a surgery on the palm during which fascia is removed.

As an interesting aside the reader will note, above, that needle aponeurotomy was noted to also be called a palmar fasciotomy.  The ending, “-otomy” means that the surgery is done to cut into the body but nothing is removed, not even the fascia. A common “-otomy” surgery is a tracheotomy in which a hole is placed in the trachea, so that breathing can take place through the opening, and noting is removed.  So, a palmar fasciotomy is a surgery on the palm during which no fascia is removed.

Not all palmar fasciectomy is performed the same. The type and extent of a palmar fasciectomy is determined by the patient’s history of previous hand injury and surgical treatment, occupation, age, family genetics and family history of the Dupuytren’s contracture, severity and location of contracture, degree of disability, and general health status.

Different types of this Dupuytren surgery include a complete palmar fasciectomy (rarely done because of typically bad results after such large tissue removal), partial or selective palmar fasciectomy, fasciectomy with skin grafting, and amputation.