Dupuytrens Contraction vs.
Dupuytrens Contracture

A disabling hand problem

Dupuytren’s Contraction is actually not the correct name of this disease, although it is very close to being correct. The correct name is Dupuytrens contracture, not Dupuytren’s contraction; this is common and easy mistake to make. You will find that if you enter the incorrect name into a search engine request you will not get the same range of responses as for the correct name, nor will you get as many responses.

Even though Dupuytren’s contraction is not the correct term, it does convey the fundamental idea of this disease process which is the contraction or shortening of the fibrous fascial tissue of the palm. Here is the difference between the two terms:

Dupuytrens contraction refers to what happens to the deep tissue layer of the palm, the actual drawing up and tightening of the fascial layer over the tendons of the fingers. A contraction is a verb that describes the movement or shortening in size of a tissue or area of the body. You might say that Dupuytrens contraction is a movement of the tissue that causes the contracture that can be seen and felt on the palm of the hand.

Dupuytrens contracture refers to the end result of the tissue as a result of this disease process itself. A contracture is a noun that describes the permanent contraction of tissue or an area of the body. You might say that Dupuytrens contracture is the problem that causes the finger(s) to assume a flexed position due to the Dupuytrens contraction and drawing up of the fascial tissue.

Dupuytrens contracture of the left hand, ring finger, causing
significant flexion deformity with resultant inability to straighten finger

The contraction of tissue that occurs in the palm of the hand in a process is caused by the overabundance of a specialized type of cell called a fibroblast that rapidly grows in the deep tissue layer of the hand. This greater than average collection of fibroblasts secretes a large deposit of a specialized protein, called collagen, in that area. Collagen is strong and fibrous, and is normally abundant in skin, muscles, tendons, ligaments and bone; it gives these tissues strength and flexibility. Exactly why this uncontrolled growth of fibroblasts in the fascia (deeper connective tissue layer) of the palm begins, and why it continues to the point of creating a limiting and distorting permanent flexion contracture of the hand, is unknown. Some recent studies in the U.S. and elsewhere indicate that it could be due to the presence of what are known as “growth factors” in the palmar tissue, such as fibroblast growth factor, transforming growth factor-beta and platelet-derived growth.

There are basically three stages to Dupuytrens contraction process. However, these steps do not necessarily occur as distinctly as they are presented here. Often one blends into the other, and oftentimes two stages occur at the same time in different areas of the hand.

1. Proliferative stage – first sign of development of one or more contracted nodules, the characteristic lesion of Dupuytren disease, in the palmar tissue. These nodules contain an abundance of fibroblasts and type III collagen. This is the most biologically active and rapid phase of Dupuytrens disease when it is common for multiple painful nodules to develop near the palmar crease closest to the base of the fingers or even at the base of the fingers.

2. Active contractile stage – starts once the nodules are well developed. This stages usually progresses more slowly than the first, as dense tendon-like “cords” of fibrous tissue appear proximal to the nodules, along with deep grooves or pits are seen in the skin due to the skin being firmly fixed to the underlying fibrous tissue below the upper skin layer. A new type of cell, the myofibroblasts, appears and takes the place of the fibroblasts as the most common cell present in the tissue. These myofibroblasts share characteristics and features of both fibroblasts and smooth muscle tissue; they also can make collagen, but also are capable of contraction. They spread throughout the palmar soft tissue and fascia, as well as being interconnected to each other, thus allowing for significant contraction of the palm of the hand. During this stage type III and V collagen is found in greater abundance under the skin of the palm.

3. Advanced disease, or residual stage – slowest and least spectacular stage, compared to the other two. During this time the nodules become smaller and less well defined, and the major knuckles of the hand – MCP or metacarpophalangeal joint (where the fingers meet the palm, and the PIP or proximal interphalangeal joint (the first joint of each finger going away from the palm) – develop thickened and hardened contractures. Also, the cords or bands that started in the second stage are now better developed and stand out more clearly. They are made of type I collagen and only a small number of fibroblasts or myofibroblasts remain at this stage. As a result of this cellular activity the fingers develop the greatest degree of flexion contraction deformity.

With this understanding of what happens at the cellular level at the finger joints and palm of the hand during the different stages of Dupuytrens contracture it is easy to understand why a person would be inclined to think that Dupuytrens contraction is the name of the condition.

Apparently, this abnormal tissue chemistry and physiology can be influenced and benefited by using natural Alternative Medicine therapy methods. To find out more about getting started treating your Dupuytrens contraction in a different way, click on Dupuytrens treatment.

For ideas and suggestions to organize an effective Alternative Medicine treatment plan, click Create Dupuytrens Treatment Plan