Dupuytren's
Locked fingers can be skilfully treated by Dr Oscar Brumby-Rendell.
Dupuytren's (pronounced du-pwe-tranz) contracture, or Viking's disease, is a progressive condition that can lead to hand deformity.
The tissue located under the palm (the palmar fascia) is affected by this condition. The role of the palmar fascia is to stabilise the palm's skin, and Dupuytren's contracture results in this tissue becoming tight and thick. Over time, the fingers begin to move downwards, in the direction of the palm, due to the creation of a thick chord.
Generally, the fourth and fifth fingers are affected by this condition. Progressively, patients become unable to straighten their fingers due to involuntary inward bending.
Symptoms of Dupuytren's contracture
Living with a locked up finger
Individuals with Dupuytren's contracture find it challenging to perform normal activities, and their working capacity is often reduced.
Changing clothes, gripping objects, typing and shaking hands may become difficult. As this disease rarely affects the index finger and thumb, various activities (including writing and driving) are still within an individual's abilities.
This condition is progressive and generally is not associated with any pain.
Symptoms vary depending on how far the disease has progressed.
Initially, Dupuytren's contracture is marked by the palm's skin thickening and over time, the skin may become dimpled or puckered. The skin may become sensitive (not painful) due to nodules or lumps developing under the skin.
Tissue cords may extend from under the palm's skin to the fingers in later Dupuytren's stages, resulting in the fingers moving inwards. This disease can occur in either a singular or both hands. However, if it is the latter, one hand generally has a more severe condition.
Causes of Dupuytren's contracture
The causes of this disease are largely unknown. Medical research does not suggest that this disease is caused by overuse or hand trauma. This is contrary to many other hand and wrist conditions, such as carpal tunnel syndrome.
However, numerous factors are thought to increase the risk of developing Dupuytren's contracture, including:
- Age - Most individuals with the condition are above the age of 50.
- Gender - More men develop and have severe cases of this condition.
- Ancestry - People of Celtic, Northern European, or Scandinavian descent are more prone to this condition.
- Heredity - This condition seems to run in families.
- Medical conditions - Epilepsy and diabetes seem to increase the risk of developing this disease.
- Tobacco and alcohol use - Smokers and alcoholics are more prone to this condition.
Diagnosis
Dr Brumby-Rendell will discuss your medical history and symptoms and conduct a physical examination to make a diagnosis (Dupuytren's contracture has many visible indicators). He may also put pressure on different finger or hand parts to evaluate tissue health. Dr Brumby-Rendell will specifically note:
- Tough tissue bands or knots
- Finger and thumb motion range
- Thumb, finger and hand sensitivity
Your condition's progression will be documented through these notes and photographs of your hand(s).
Treatment options for Dupuytren's contracture
Non-surgical measures can be implemented for many cases of this condition.
Affected nodules may be injected with corticosteroids to reduce contracture progression.
Other treatments, such as gamma interferon treatment, calcium channel blockers, and percutaneous needle fasciotomy, are thought to relieve disease symptoms; however, there is currently no understood cure.
Isolated, primary central cords may be broken by Xiaflex collagenase injections; however, this treatment is not covered by Medicare and is unsuitable for individuals with complex or multiple cords.
Surgery may be advised to increase finger motion range if your hand cannot function due to Dupuytren's contracture. Surgical techniques may involve:
- The creation of small incisions to release fascia bands
- Movement restoration through the removal of thickened fascia
- The use of a skin graft to repair the palm, and the removal of fascia and associated skin
Surgical Treatment: Finger Release Surgery
The removal of diseased tissue (Dupuytren's dematofasciectomy) is generally best conducted via open surgery.
Dr Brumby-Rendell is an Adelaide-based orthopaedic surgeon in Adelaide who aims to minimise trauma and optimise recovery through implementing minimally invasive techniques.
When possible, arthroscopy (keyhole surgery) is used as it decreases hospital stay periods and minimises infection risks. Dr Brumby-Rendell will advise a tailored treatment plan to promote surgical success and limit disruption to your everyday life.
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