A restriction of the hand is synonymous with a massive limitation of our usual everyday life. Dupuytren's disease , also known as Dupuytren's disease, leads to restricted movement of one or more fingers - Dupuytren's contracture .
Along the tendons of the palm of the hand, a strand of collagen fibres develops over the course of months or years. This pulls on one or more fingers and over time prevents the fingers from stretching fully.
In Dupuytren's disease, a strand of collagen slowly develops in the palm of the hand What happens in Dupuytren's contracture ? What are the causes of the condition and how can it be treated ? Why is movement so crucial after surgical treatment? We deal with these questions in the following article.
What happens in Dupuytren's contracture?
Dupuytren's disease is a benign growth in the connective tissue of the palm. The ring or little finger are usually affected, but the disease can also occur on the other fingers.
At first, individual nodules form in the palm of the hand. Gradually, strands of collagen also grow parallel to the flexor tendons in the palm. Over time, these become stronger and pull individual fingers towards the palm. When the extension of the fingers is gradually no longer possible, this is called Dupuytren's contracture .
Initially, nodules form in the palm of the hand, over time a collagen strand develops As long as no nerves are affected by the growth, Dupuytren's disease does not cause pain . However, the affected fingers become increasingly immobile and obstructive in everyday use of the hand.
It can take years after the first appearance of lumps in the palm of the hand before these restrictions occur. Many of those affected also remain completely unaffected by movement restrictions. Dupuytren's disease usually progresses slowly, even a temporary standstill or more severe relapses are possible.
Caution: Not every nodular change in the hand is due to Dupuytren. It is therefore essential to seek medical advice to confirm the diagnosis and rule out other conditions.
Dupuytren's disease: Causes
The exact causes of how Dupuytren's disease can develop have not yet been conclusively explained. However, there are some factors that make the onset of the disease more likely.
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What factors influence the onset of Dupuytren's disease?
Age Gender Geographical location Risk factors smoking, alcohol and diabetes Genetic component
Dupuytren's disease occurs more frequently with increasing age
Dupuytren's disease affects people from the age of 50 . The German Dupuytren Society states that up to 25% of 50-year-olds and up to 50% of 80-year-olds have the disease.
It should be noted, however, that by no means all outbreaks have to be treated. A much smaller number of about 45,000 patients per year in Germany are so severely restricted in their hand movement that they undergo surgery .
Men are more affected than women
In men, the disease starts earlier in life, so Dupuytren's disease is more pronounced in them than in women. This is why more men than women need surgery. Why gender is linked to the disease has not been conclusively explained.
Dupuytren's disease more common in industrialised countries
Interestingly, Dupuytren's disease appears primarily in Central and Northern Europe as well as North America, less frequently in Africa and Asia. Here, too, the reason has not yet been precisely investigated.
Risk factors for Dupuytren's disease: diabetes, smoking, alcohol
There seems to be a connection between diabetes and Dupuytren' s disease, as diabetics are more frequently affected. Hand injuries or heavy strain on the hand over many years can also promote the onset - although research is not yet complete here either.
Dupuytren's disease cannot really be prevented, but two important risk factors that can promote its onset can be avoided. Smokers and people with high alcohol consumption are more likely to develop Dupuytren's disease. So if you avoid nicotine and alcohol , you can reduce your risk of developing the hand disease.
Genetic component of Dupuytren's disease
Finally, genetics also play a role in whether or not you will develop Dupuytren's disease in your lifetime. If several family members already have the disease, it is more likely that you will also discover the typical nodules in the palm of your hand as you get older. The familial clustering is therefore also addressed in the medical diagnosis .
Dupuytren's disease treatment: What alternatives are there?
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Dupuytren's disease therapy . What are the options?
Operation Needle fasciotomy Collagenase treatment Radiotherapy
Since the cause of Dupuytren's disease is not fully understood, there is little you can do yourself - apart from abstaining from nicotine and alcohol - to prevent an outbreak or delay the progression of the disease.
Conservative treatments such as medication, physiotherapy or massages usually do not bring any significant improvement either. Therefore, those affected only have the choice between various invasive interventions. As with any surgery, Dupuytren' s disease surgery involves certain risks. For this reason, it is usually only performed when the restricted movement severely impedes the daily life of the affected person and minimally invasive therapies are no longer sufficient.
In Germany, up to 45,000 operations or minimally invasive procedures are performed annually in connection with Dupuytren's disease. Compared to the high number of people who become ill with advancing age, only a few of the sufferers ultimately require surgery.
Dupuytren's disease surgery
Patients should only consider surgery if the hand's restricted movement is a heavy burden on their daily lives and the hand is becoming more and more unusable. Beforehand, medical advice should be sought regarding minimally invasive procedures.
It is therefore recommended to delay the operation as long as possible. On the one hand, surgery always involves certain risks. On the other hand, recurrence often occurs after Dupuytren's disease surgery . This means that the typical lumps and strands reappear a few years later.
Schematic representation of the scar of a Dupuytren operation
Since scar tissue forms, as with any operation, a second or even third operation is much more difficult and should be avoided.
During the procedure, the skin and connective tissue of the palm are incised in a zigzag pattern to release the tension in the tissue and allow the finger to be stretched again. The resulting scar is accordingly quite long and requires good aftercare.
Needle fasciotomy
Needle fasciotomy can be an alternative treatment instead of surgery: It can take place on an outpatient basis without anaesthesia and can also be performed several times if a recurrence occurs. The collagen strand caused by Dupuytren's disease is weakened with many needle punctures so that it gives way and allows the finger to move again.
The disadvantage of this treatment method is that the disease comes back more quickly compared to surgery, i.e. a relapse develops in a shorter time. Nevertheless, this minor procedure can be a good way to delay Dupuytren surgery.
Needle fasciotomy involves weakening the collagen strand with needle punctures Collagenase
Therapy with collagenase is similar to needle fasciotomy: however, instead of only mechanically weakening the connective tissue strand with needle pricks, collagenase therapy also involves injecting an enzyme into the strand. The cord that pulls on the fingers in Dupuytren's contracture is made of collagen. The enzyme collagenase can dissolve this substance and thus break the cord. If the finger is now stretched, the strand breaks and the finger is mobile again.
The collagenase therapy against Dupuytren is approved in Germany, but the appropriate medication is no longer sold here. It can be imported, but not all health insurance companies cover the costs.
Seek medical advice to decide whether needle fasciotomy without collagenase may be a suitable solution.
Radiotherapy
Radiation with X-rays or electrons is considered when Dupuytren's disease is active but still in its early stages . The rays are directed to the nodes in the palm of the hand and limit the ability of the proliferating cells to divide there. In this way, a standstill can be achieved or the disease can at least be slowed down. Smaller nodes can even disappear.
Similar to needle fasciotomy and collagenase application, radiotherapy is also a way to delay surgery . For this, it is important to start treatment in the early stages. If Dupuytren's contracture has already developed, radiotherapy is unlikely to be effective.
The radiation used can be limited to the areas of the hand affected by Dupuytren's disease. Nevertheless, it is important to weigh up the risks and benefits of radiation treatment in consultation with specialists.
Why is movement important in the healing process?
Cautious movement in the healing process
more elastic scar Avoid adhesions Lymph on the move
The operation has created a Wound scar does not correspond to the original skin layers and is less elastic. If you move your hand carefully during the healing process, there is a pull on the scar tissue that is forming. In this way, the tissue stiffens less and remains supple.
Additional therapy time with the AnyHand
More info After a Dupuytren operation , it can also happen that the scar tissue grows together with surrounding structures, for example with a tendon. This would in turn lead to movement restrictions in the course of the operation. Exercises are also useful here: if you move your hand, the tendon slides back and forth and cannot grow together with the scar tissue.
If the hand remains in motion, the scar may be more difficult to fuse with a tendon If the hand remains immobile for a long time after the operation, lymph fluid can also accumulate and the hand swells. The accumulation of fluid can lead to an unpleasant pressure pain. With regular movement, the lymph keeps moving and does not accumulate in the hand.
We see: After a Dupuytren operation , exercise therapy is useful and important. The exercises should always be discussed with the medical or therapeutic side so as not to hinder the healing process.
Frequently asked questions
What can be done about Dupuytren's disease?
In many patients, the course of Dupuytren' s disease is painless. Therefore, treatment is not necessarily required for every diagnosis. Common treatment options (mostly in the advanced stage) are: Surgery (fasciectomy), needle fasciotomy, injection of collagenase and radiotherapy.
Who treats Dupuytren's disease?
Dupuytren's disease specialists are usually specialists in hand and plastic surgery. They can treat Dupuytren's disease.
Can Dupuytren's contracture be treated by surgery?
Those affected should only consider surgery if the hand's restricted movement places a heavy burden on them in everyday life and the hand becomes more and more unusable. Surgery can improve the symptoms of Dupuytren's contracture . However, the symptoms of Dupuytren's disease often reappear after a certain time.
How does Dupuytren's disease develop?
The exact cause of Dupuytren's disease has not yet been clarified. In addition to hereditary predisposition, external factors such as an injury are discussed as triggers.
This article deals with a health topic, but is not suitable for self-diagnosis or the selection of a suitable therapy. The individual case can only be reliably diagnosed by medical expertise.
More movement therapy for your everyday life? more infos Sources
German Dupuytren Society https://www.dupuytren-online.de/index.html
Oppermann et. al. (2017): Percutaneous needle aponeurotomy for Dupuytren's contracture https://link.springer.com/article/10.1007%2Fs00132-017-3388-4
Waldner-Nilsson (ed.) (2013): Hand Rehabilitation. Volume 1 Fundamentals, Diseases. Heidelberg / Berlin: Springer-Verlag.
Waldner-Nilsson (ed.) (2013): Hand Rehabilitation. Volume 2 Injuries. Heidelberg / Berlin: Springer-Verlag.
