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Wednesday, March 24, 2021

Dupuytren’s disease

Dupuytren’s disease manifests itself with thickening and contraction of palmar fasciitis (aponeurosis). Clinical image is typical and recognizable. Hand area looks like a thick rope, with finger pain and flexion contracture (inability to extend it) – usually the fourth finger is involved, sometimes fifth.

Knots can be palpated in this thick area of skin. Finger contracture happens in metacarpophalangeal and then in interphalangeal joint.   

In the very beginning the skin ripples and wrinkles above the affected area, and later it can grow together with fascia (aponeurosis) beneath it so finger flexion contracture occurs because tendons and membranes have not been altered.  
Cause of this disease remains unknown, but genetics can play an important part. It occurs in people experiencing problems with diabetes, alcoholism, or epilepsy.

Early stage treatment involves local ultrasoundlaser therapy, and stretching via kinesitherapy, as well as corticosteroid infiltration. Therapy is not always successful, so sometimes we perform surgical procedures (fasciotomy). 

Similar occurrence can happen on the foot and is called Ledderhose’s disease. Usually it doesn’t lead to greater problems.

On the dorsal area of proximal interphalangeal finger joints skin and subskin can grow thick in a shape of round bordered pillow. These skin pillows are rare, do not affect hand function, usually cause no problems, and can be combined with Dupuytren’s disease.

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