Dupuytren's contracture

Not to be confused with Dupuytren fracture.
Dupuytren's contracture
Other namesDupuytren's disease, Morbus Dupuytren, palmar fibromatosis, Viking disease, and Celtic hand,[1] contraction of palmar fascia, palmar fascial fibromatosis, palmar fibromas[2]
Dupuytren's contracture of the ring finger
Pronunciation
SpecialtyRheumatology
SymptomsOne or more fingers permanently bent in a flexed position, hard nodule just under the skin of the palm[2]
ComplicationsTrouble preparing food or writing[2]
Usual onsetGradual onset in males over 50[2]
CausesUnknown[4]
Risk factorsFamily history, alcoholism, smoking, thyroid problems, liver disease, diabetes, epilepsy[2][4]
Diagnostic methodBased on symptoms[4]
TreatmentSteroid injections, clostridial collagenase injections, surgery[4][5]
Frequency~5% (US)[2]

Dupuytren's contracture (also called Dupuytren's disease, Morbus Dupuytren, Viking disease, palmar fibromatosis and Celtic hand) is a condition in which one or more fingers become permanently bent in a flexed position.[2] It is named after Guillaume Dupuytren, who first described the underlying mechanism of action, followed by the first successful operation in 1831 and publication of the results in The Lancet in 1834.[6] It usually begins as small, hard nodules just under the skin of the palm,[2] then worsens over time until the fingers can no longer be fully straightened. While typically not painful, some aching or itching, or pain,[7] may be present.[2] The ring finger followed by the little and middle fingers are most commonly affected.[2] It can affect one or both hands.[8] The condition can interfere with activities such as preparing food, writing, putting the hand in a tight pocket, putting on gloves, or shaking hands.[2]

The cause is unknown but might have a genetic component.[4] Risk factors include family history, alcoholism, smoking, thyroid problems, liver disease, diabetes, previous hand trauma, and epilepsy.[2][4] The underlying mechanism involves the formation of abnormal connective tissue within the palmar fascia.[2] Diagnosis is usually based on a physical exam.[4] Blood tests or imaging studies are not usually necessary.[8]

Initial treatment is typically with cortisone injected into the affected area, occupational therapy, and physical therapy.[4] Among those who worsen, clostridial collagenase injections or surgery may be tried.[4][5] Radiation therapy may be used to treat this condition.[9] The Royal College of Radiologists (RCR) Faculty of Clinical Oncology concluded that radiotherapy is effective in early stage disease which has progressed within the last 6 to 12 months. The condition may recur at some time after treatment;[4] it can then be treated again. It is easier to treat when the amount of finger bending is more mild.[8]

It was once believed that Dupuytren's most often occurs in white males over the age of 50[2] and is rare among Asians and Africans.[6] It sometimes was called "Viking disease," since it was often recorded among those of Nordic descent.[6] In Norway, about 30% of men over 60 years old have the condition, while in the United States about 5% of people are affected at some point in time.[2] In the United Kingdom, about 20% of people over 65 have some form of the disease.[6]

More recent and wider studies show the highest prevalence in Africa (17 percent), Asia (15 percent).[10]

  1. ^ Fitzpatrick's dermatology in general medicine (6th ed.). New York [u.a.]: McGraw-Hill. 2003. p. 989. ISBN 978-0-07-138076-8.
  2. ^ a b c d e f g h i j k l m n o "Dupuytren contracture". Genetics Home Reference. US: United States National Library of Medicine, National Institutes of Health. 1 April 2019. Archived from the original on 13 May 2017.
  3. ^ "Dupuytren's contracture". Merriam-Webster.com. Retrieved 12 March 2018.
  4. ^ a b c d e f g h i j "Dupuytren's Contracture". National Organization for Rare Disorders. 2005. Archived from the original on 10 September 2017. Retrieved 3 June 2017.
  5. ^ a b Brazzelli M, Cruickshank M, Tassie E, McNamee P, Robertson C, Elders A, et al. (October 2015). "Collagenase clostridium histolyticum for the treatment of Dupuytren's contracture: systematic review and economic evaluation". Health Technology Assessment. 19 (90): 1–202. doi:10.3310/hta19900. PMC 4781188. PMID 26524616.
  6. ^ a b c d Hart MG, Hooper G (2005). "Clinical associations of Dupuytren's disease". Postgraduate Medical Journal. 81 (957): 425–28. doi:10.1136/pgmj.2004.027425. PMC 1743313. PMID 15998816.
  7. ^ Cite error: The named reference voncampe was invoked but never defined (see the help page).
  8. ^ a b c The American Society for Surgery of the Hand (2021). "Dupuytren's Contracture". HandCare: The Upper Extremity Expert. Retrieved July 28, 2022.
  9. ^ Kadhum M, Smock E, Khan A, Fleming A (1 March 2017). "Radiotherapy in Dupuytren's disease: a systematic review of the evidence". The Journal of Hand Surgery, European Volume. 42 (7): 689–92. doi:10.1177/1753193417695996. PMID 28490266. S2CID 206785758. On balance, radiotherapy should be considered an unproven treatment for early Dupuytren's disease due to a scarce evidence base and unknown long-term adverse effects.
  10. ^ Ruettermann M, Hermann RM, Khatib-Chahidi K, Werker PM (November 2021). "Dupuytren's Disease-Etiology and Treatment". Dtsch Ärztebl Int. 118 (46): 781–788. doi:10.3238/arztebl.m2021.0325. PMC 8864671. PMID 34702442.