Dupuytrens Contracture Introduction

Dupuytren's contracture (also called Dupuytren’s disease, Viking disease, Palmar Fasciitis) is a common disease of the hand, usually not painful, in which the fingers bend toward the palm and cannot be straightened to a flat position.

Dupuytrens contracture is named after can Guillaume Dupuytren, a French surgeon, who was the first to provide a detailed description of the disease in 1831. Although the problem had been discussed as early as 1614 by Plater, Dupuytren’s was the first and most thorough serious study by modern standards, with classic dissections and detailed description so that his name will forever be associated with the condition.

Baron Guillaume Dupuytren

Technically, Dupuytrens contracture is a fibroproliferative disease of the palmar fascia. This means that the cells that are responsible for making the tissue tough and strong (fibroblasts, myofibroblasts, and the collagen that both of these cells manufacture) are created to great excess in and around the thin but tough layer of tissue in the palm just above the fingers tendons. This is the basic pathology of Dupuytrens contracture.

Overview
Dupuytrens contracture is often first noticed as a small painless lump, depression or pit in the palm of the hand. The skin and fascia (thin but tough layer of fibrous tissue between the skin of the palm and the underlying flexor tendons of the fingers) of the palm begin to feel dense and hard. At about this time the victim will notice that the palm cannot be placed flat on an even surface, such as a table top. This is a progressive disease, but it is not possible to predict how quickly it may develop, or the eventual severity of the hand deformity or incapacity that results.

Dupuytrens contracture of the right hand, showing severe flexion deformity of the
little and ring fingers, and moderate flexion deformity of the middle finger

In Dupuytrens contracture the thin but tough fascia on the palm side of the hand thickens - as much as 0.5cm – and then essentially "shrinks", resulting in a tight contracture in the area of the palm and fingers that the diseased tissue overlies. Initially the lesion is described as a nodule or lump, later this characteristic formation develops into a cord or band that restricts finger extension or straightening.

To understand Dupuytrens contracture it is good to know a few common
anatomical terms to describe parts and areas of the finger and hand


Dupuytrens contracture – drawing showing location of fascia below the skin,
and how it is the fascia that contracts causing inability to straighten finger(s)
affected and dimpling of the overlying tissue above the contraction


Dupuytrens contracture – dual illustration of surface changes and
underlying tissue involvement, showing the hand anatomy that is affected

Dupuytrens contracture – another dual illustration of surface changes and
underlying tissue involvement, showing the hand anatomy that is affected

Dupuytrens contracture is a slowly progressing condition, occurring most often in the fourth and fifth digits (ring and little fingers), that first appears in middle age persons; however, if there is a strong family history of severe hand contracture it can occur as early as age twenty, especially in males. One finger or all of the fingers could become involved. The index finger and thumb are seldom involved. The distal joints (closest to the fingertips) are never affected.

In time the fingers may be drawn down permanently into the palm. Flexing or bending the fingers is not a problem; straightening them becomes progressively more difficult or impossible if the disease is severe. Eventually there is variable difficulty with common daily activities (washing hands, dressing, wearing gloves, handling tools, shaking hands or placing them in pockets).

It has been associated with diabetes and can be seen in alcoholics with cirrhosis of the liver. It has also been associated with epilepsy, but may be a result of the use of anticonvulsant drugs rather than the presence of epilepsy itself. Like other similar soft-tissue disease, the cause remains unknown.

Incidence
Dupuytrens contracture is found most commonly in white males of North European ancestry. Approximately 80% of affected individuals are male; this predisposition is consistent in all countries and races. It affects up to 39% of males over the age of 60 and although less prevalent in women differences decrease as age increases. It is slightly more common in non-manual workers, although there are studies that suggest it could be work-related.

The average of disease onset in males is 49 years, and in females, the average age is 54 years. The average age for surgery for males is 58 years, and for females is 62 years.

Dupuytrens contracture is seen eight times more frequently in men than women. When Dupuytrens contracture occurs in a woman it is usually a mild case. Not only are men are more likely to develop the problem, they will develop the first symptoms earlier than women. People with epilepsy, diabetes, pulmonary tuberculosis, liver disease, or alcoholism are statistically more prone to Dupuytren's. The most progressive and severe for of Dupuytrens contracture occurs in white males under the age of 40. The youngest case reported was an 11 year-old girl, whose father had a severe case of Dupuytrens contracture in both hands.

Finger Facts
Ring finger is the most commonly affected finger.
Little finger is the second most commonly affected finger.
Thumb and index fingers are rarely affected
27-68% of cases have a positive family history of Dupuytrens contracture
33% of cases involve only one finger.
33%of cases involve two fingers.
33% of cases involve more than two fingers.
65% of cases affect both hands
Dupuytren's is more common in the right hand,
The most usual sequence or order that the fingers are affected:
     Ring
     Small
     Middle
     Thumb
     Index

Dupuytrens contracture can cause a person to lose the full and normal use of one or both hands. It is a serious problem that should be met just as seriously with an aggressive therapy plan that utilizes as many of the conservative measures that are outlined on this website. Go to Dupuytrens Alternative Treatment to find out more about what can be done to assist the body to resolve or minimize this problem.

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