Dupuytren’s contracture is a condition that affects the hands and fingers, causing at least one finger, typically the ring or little finger, to bend into the palm. It’s caused by the thickening and tightening of the palmar fascia, which leads to the formation of nodules and cords. The progression can vary between individuals, with some experiencing a slow onset and others a faster one. The classic presentation is flexion of the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joints, as seen in this photograph.
The condition is often associated with several risk factors. These include having a family history of the disease, certain medical conditions such as liver disease, diabetes mellitus, and epilepsy, and lifestyle factors such as high alcohol consumption. It’s also worth noting that the condition is more common in people of Northern European descent.
Yes, mature Dupuytren’s tissue typically exhibits the presence of myofibroblast cells, likely derived from fibroblasts. These are the cells responsible for the contraction of the palmar fascia. Additionally, there are also thick collagen fibers, which contribute to the thickening and contracture of the fascia.
The management of Dupuytren’s contracture includes both non-operative and operative strategies. Non-operative measures include observation, splinting, and steroid injections to reduce local tenderness. Collagenase injections have also shown promising short-term results, although long-term data is still awaited.
Surgical options include percutaneous fasciotomy, segmental or palmar fasciectomy, regional fasciectomy with or without skin grafting, dermo-fasciectomy with skin grafting, PIP joint arthrodesis, and, in severe or recurrent cases, digit amputation.
The choice of treatment depends on the severity of the contracture, the patient’s symptoms, their functional needs, and their overall health status. For example, a patient with mild symptoms and contracture might do well with non-operative management, while surgery might be more appropriate for a patient with significant functional impairment.
Surgical treatment of Dupuytren’s contracture can come with a number of risks and potential complications. These include delayed wound healing, infection, tendon, nerve, and vessel injury, and temporary or permanent numbness. There’s also a risk of digital necrosis leading to amputation, incomplete correction of the contracture, recurrence of the disease necessitating re-operation, joint stiffness, reduced flexion or extension at the PIP joint, and pain, swelling, and tenderness. In some cases, the patient may develop chronic regional pain syndrome. As with any surgical intervention, it’s crucial to discuss these risks with the patient before proceeding.