Dupuytren
Dupuytren’s disease is caused by an abnormal thickening of the palmar fascia (tissue between the skin and and the tendon and vascular nerve structures in the palm and fingers) that may limit the mobility of one or more fingers. In some patients a subcutaneous cord extends from the palm to the fingers that causes flexion of the fingers, limiting its extension. Sometimes the disease can lead to thickening of the dorsal surface of the finger joints, contracture of the penis or plantar surface of the feet.

Cause

The cause of the disease is unknown and there is no permanent cure. It is usually painless and has no tumor characteristics. It most often affects people of Celtic background (often there is a family history), men being more affected than women and an early onset is usually more aggressive, as are people who have affected other areas of the body. Some forms may be associated with trauma, diabetes and taking some drugs (tuberculostatic).

Signals and symptons

It usually develops slowly with the appearance of a nodule at the level of the distal fold of the palm, most often in the 4th and 5th fingers, and then develops with a cord between the palm and fingers, progressively leading to the retraction of the palm over the fingers. palm with interference with daily activities. The skin may be involved, but tendons and vascular-nervous structures are not affected.


Non Surgical Treatment

The goal of treatment is to eliminate finger contracture and restore hand functionality. The mere presence of a nodule is not itself a surgical indication, the retraction of the fingers and the functional limitation caused determine the indication for treatment.

Some non-surgical alternatives such as percutaneous interruption of the rope with a needle but with a high relapse rate. An alternative with a lower relapse rate is the injection of a collagenase that causes the rope to be destroyed in a given area, allowing the finger to extend.

Surgical treatment

There is no definitive cure for Dupuytren’s disease, which may recur at the same site or appear in a new zone more or less frequently, but regional, enlarged or total fasciectomy is the method with the lowest recurrence rate. In some more severe cases it may be necessary to interpose a skin graft or use a local flap to cover some tendon or vascular-nervous structures.

When the contracture of the fingers is already very severe, a full extension of the fingers may not be achieved and in many situations a physical therapy program is necessary until the normal functioning of the hand.