Dupuytren’s contracture
Dupuytren’s contracture is a thickening of the palm of the hand that happens slowly and is caused by inflammation. It starts in the ring and little fingers and can spread to the rest of the hand if it is not treated early. It’s also called Palmer fasciitis or Viking Hand. Even though medical help may be needed in the long run, we’ll talk about lifestyle and self-help options that may help slow the disease’s progression and are a good choice in the early stages.
Early signs: The skin on the palm of your hand usually gets thicker when you have Dupuytren’s contracture. The skin on the palm of your hand may look puckered or dimpled as Dupuytren’s contracture gets worse. On the palm, a firm lump of tissue might form. This lump might hurt if you touch it, but it’s usually not painful.
Cords of tissue form under the skin on your palm and may reach up to your fingers in the later stages of Dupuytren’s contracture. When these cords get tighter, they may pull your fingers towards your palm, sometimes very hard. When this happens, the fingers that have Dupuytren’s contracture can’t be fully straightened. This can make it harder to do normal things like shaking hands, putting gloves on, or putting your hands in your pockets. That doesn’t happen very often with the thumb and index finger. Dupuytren’s contracture can happen in either hand, but more often than not, one hand is worse than the other.
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Lifestyle and self-help strategies
1. Stretch (see film)
- Gently bend your fingers backwards from your palm
- With your fingers on the edge of a table, palm down, lift the palm upward gradually, keeping your fingers flat
- Rotate the wrist from side to side
- Put your hand in a prayer position, pushing the palms and fingers together
- Do not overstretch and cause pain as this may be counterproductive
2. Massage / oils
- Before stretching, warm your hands in warm water or with a heat pack
- Avoid heavily scented creams
- Avoid creams with hydrocarbons and artificial irritation ingredients
- Use a natural plant-based anti-inflammatory moisturiser such as Dupuytren’s relief balm
- Massage your palms in all directions on and around the thickening
3. Protect your hands:
- Avoid an uncomfortable grip on tools by covering the handles with pipe insulation or cushion tape
- Use gloves with heavy padding during heavy grasping tasks
4. Improve your general health:
Underlying Causes
The deformity is caused by fibrosis and thickening around the tendon sheaths of the hand. The condition is known to be associated with:
- Age – Dupuytren’s contracture typically occurs after the age of 50
- Cancer treatments – Particularly long term hormone therapies such as aromatase inhibitors
- Sex – Men are more likely to develop Dupuytren’s and to have more severe contractures than women
- Ancestry – People of Northern European (Viking) descent are at higher risk of the disease
- Family history – Dupuytren’s contracture often runs in families
- Tobacco smoking – Perhaps because of microscopic changes within blood vessels caused by smoking
- Alcohol – High alcohol intake is associated with an increased risk, especially if cirrhosis develops
- Other lifestyle factors – Lack of exercise, high saturated fat and low omega 3 and polyphenol intake
- Diabetes – People with diabetes are reported to have an increased risk of Dupuytren’s contracture
- Medication – Drugs including phenytoin and aromatase inhibitors are linked to the condition
Medical Treatments for Dupuytren’s.
Needling and enzyme injections:
In this method, a needle is put through the skin to puncture and “break” the tissue cord that is tightening a finger. Contractures often happen again, but the procedure can be done again. Some doctors now use ultrasound to guide the needle, which makes it less likely that nerves or tendons will get hurt by accident.
The best things about the needling method are that it doesn’t require any cuts, it can be done on multiple fingers at once, and most people don’t need much physical therapy afterward. One bad thing about it is that it can’t be used in some places on the finger because it could hurt nerves.
The Food and Drug Administration recently said that collagenase clostridium histolyticum (Xiaflex) injections can be used to treat Dupuytren’s contracture. The drug’s enzyme makes the tight cord in your palm softer and less strong. The next day, after the shot, your doctor will move your hand around to try to break the cord and straighten your fingers.
This is a lot like the needling technique, but the manipulation takes place the next day instead of during the injection procedure. The good and bad points of the enzyme injection are similar to those of needling, though the enzyme injection may hurt more at first. At this time, enzyme injections can only be used on one joint at a time, and each treatment must be at least one month apart.
Radiation therapy:
If you have Dupuytren’s disease early on, radiotherapy can stop or slow it down without surgery. In radiation therapy, the nodules and cords that are linked to Dupuytren’s are hit from 0.5 to 1 cm away with either electrons (3–10 MeV) or X-rays (e.g. 120 kV = soft X-rays that don’t go deep into the body). Of course, this is done five days in a row, for a total dose of 15 Gy. This treatment is done again after six weeks have passed.
Surgery:
You could also have the body part in your palm that is sick surgically removed. This could be hard to do because it’s hard to tell which tissues are sick in the very early stages of the disease. Diseased tissue can also stick to the skin, making it hard to get rid of and raising the risk of recurrence.
One of the best things about surgery is that it releases the joint more completely than the needle or enzyme methods. The main problems are that you may need physical therapy after surgery and it may take longer to heal.
In the worst cases, surgeons cut away all the tissue that Dupuytren’s contracture is likely to affect, even the skin that is attached to it. In this case, the open wound will need to be covered with a skin graft. This surgery is the most invasive and takes the longest to heal from. After that, most people need months of intense physical therapy.