Understanding Dupuytren's Disease Cause and Risk Factors
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on August 14, 2024
Dupuytren's disease, also known as Dupuytren's contracture, is a progressive condition affecting the palmar fascia of the hand. It causes nodules and fibrous cords to form, which gradually contract and pull the fingers inward towards the palm. This can severely limit hand function, making tasks like grasping objects or shaking hands difficult.
The prevalence of Dupuytren's disease varies among different populations, with higher rates observed in individuals of Northern European descent (Gudmundsson, Arngrimsson, & Sigfusson, 2019). This condition significantly impacts quality of life due to its progressive nature and the resultant finger contractures.
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What is Dupuytren's Disease?
Dupuytren's disease involves the thickening and tightening of the palmar fascia, a tissue layer beneath the skin of the palm. It starts with small nodules that develop into cords, extending into the fingers and causing them to bend inward. This process, known as contracture, restricts finger movement and can lead to considerable disability over time (Rayan & Murray, 2007).
Causes and risk factors of Dupuytren's disease
Genetic predisposition: Dupuytren's disease has a strong genetic component, often running in families due to identified gene mutations.
Age and gender factors: It typically affects adults over 50, with a higher prevalence in men compared to women.
Ethnicity: More common among individuals of Northern European descent, including Scandinavian and Celtic ancestry.
Environmental factors: Occupational activities involving repetitive hand movements, along with lifestyle factors like smoking and alcohol use, may increase risk.
Medical conditions: Diabetes, epilepsy, and cardiovascular diseases are associated with an increased risk of Dupuytren's disease.
Signs and symptoms of Dupuytren's disease
Early signs: Initial symptoms include nodules and skin pitting on the palm.
Progression: The condition progresses with the development of thickened cords and finger contractures.
Affected fingers: Typically affects the ring and little fingers most commonly.
Impact on daily activities: Leads to difficulties in tasks requiring hand dexterity, such as grasping objects or shaking hands.
Pain levels: Pain is not typically a prominent symptom in Dupuytren's disease.
Diagnosis of Dupuytren's disease
Physical examination techniques: Diagnosis typically involves visual inspection to identify nodules and cords in the palm. The tabletop test assesses the ability to lay the hand flat on a surface. Measurement of range of motion helps evaluate finger flexibility and contracture severity.
Diagnostic tests: Additional tests may be necessary in complex cases or to confirm diagnosis, such as ultrasound to visualize tissue changes or MRI for detailed imaging of affected structures.
Differential diagnosis: Conditions with similar symptoms include palmar fibromatosis, trigger finger, and arthritis, which may require differentiation based on clinical findings and imaging.
Stages of Dupuytren's disease
Nodule formation: The initial stage involves the formation of small nodules or lumps within the palm. These nodules are palpable and may cause mild discomfort.
Cord development: As the disease progresses, the nodules can evolve into thickened cords of fibrous tissue. These cords extend from the palm into the fingers, gradually causing them to bend inward.
Finger contracture: In advanced stages, the fibrous cords contract further, pulling the affected fingers towards the palm. This results in progressive flexion contractures, where the fingers become permanently bent.
Timeframe for disease progression: Dupuytren's disease progresses slowly over years to decades. The exact timeframe varies among individuals and depends on factors such as genetic predisposition, severity of initial symptoms, and environmental influences.
Factors affecting progression speed: The speed of disease progression can be influenced by genetic factors, age, gender, ethnicity, and certain lifestyle choices like smoking and alcohol consumption. Additionally, the presence of other medical conditions may impact the rate at which Dupuytren's disease advances.
Treatment options for Dupuytren's disease
Non-surgical Treatments
Splinting and stretching: Splints can help straighten affected fingers and prevent contractures. Stretching exercises maintain finger flexibility and reduce stiffness.
Steroid injections: Injections of corticosteroids into affected areas can help reduce inflammation and alleviate symptoms temporarily.
Enzyme injections (collagenase): Collagenase injections dissolve the thickened cords of tissue, allowing for straightening of the fingers without surgery.
Radiation therapy: Low-dose radiation is used in early-stage disease to reduce the progression of Dupuytren's contracture by inhibiting collagen production.
Surgical Interventions
Needle aponeurotomy: A minimally invasive procedure where needles are used to puncture and break apart the thickened cords, improving finger mobility.
Fasciectomy: This surgical procedure involves removing the affected fascia (connective tissue) partially or completely to release contractures.
Dermofasciectomy: Reserved for severe cases, it involves removing both the affected fascia and overlying skin, followed by skin grafting to replace the excised tissue.
Comparison of surgical options
Each surgical option carries risks such as infection, nerve damage, and recurrence. Benefits include improved hand function and reduced contracture severity, tailored to the patient's specific needs and disease severity.
Physiotherapy for Dupuytren's disease
Role of physiotherapy in overall management
Physiotherapy is integral in the comprehensive management of Dupuytren's disease, focusing on improving hand function, reducing contractures, and enhancing overall quality of life for patients. By employing various therapeutic techniques, physiotherapists aim to address the physical limitations imposed by Dupuytren's disease and optimize hand function through both non-surgical and post-surgical interventions.
Pre-surgical physiotherapy: Preparing for treatment
Before surgery, physiotherapy aims to optimize hand mobility and strength. Techniques may include gentle stretching exercises and manual therapy to improve tissue flexibility and reduce contracture severity.
Post-treatment rehabilitation: Exercises and techniques
Following surgical interventions or non-surgical treatments like collagenase injections, physiotherapy focuses on promoting healing and restoring hand function. Rehabilitation includes specific exercises to maintain finger mobility and prevent recurrence of contractures.
Specific physiotherapy interventions:
Manual therapy techniques: Physiotherapists employ manual therapy techniques to address soft tissue restrictions and joint stiffness. These techniques help in improving tissue pliability, enhancing joint mobility, and reducing pain associated with Dupuytren's disease.
Splinting and orthotic devices: Customized splints or orthoses are utilized to support the hand during healing and prevent contracture recurrence. Splints are designed to maintain finger alignment, provide support to affected joints, and promote optimal healing post-surgery or injections.
Exercise programs for maintaining hand function: Physiotherapists design tailored exercise programs aimed at maintaining and improving hand function. These programs focus on strengthening weakened muscles, improving grip strength, enhancing finger coordination, and promoting functional independence in daily activities.
Expected outcomes and timeframes
The outcomes of physiotherapy intervention in Dupuytren's disease vary depending on the severity of the condition and individual patient factors. Physiotherapy aims to achieve improvements in hand function, including increased range of motion, reduced contracture severity, enhanced grip strength, and improved ability to perform daily tasks. The timeframe for achieving these outcomes typically ranges from several weeks to months, with the duration influenced by factors such as the patient's response to treatment, adherence to exercise programs, and the specific treatment modalities employed.
Physiotherapy in Dupuytren's disease is not only instrumental in managing symptoms but also in promoting optimal recovery and functional outcomes following treatment interventions.
Prevention and management strategies for Dupuytren's disease
Lifestyle modifications: Incorporating a balanced diet, regular exercise regimen, and stress management techniques can support overall health and potentially mitigate factors contributing to Dupuytren's disease progression.
Hand exercises: Regularly practicing specific exercises aimed at maintaining hand flexibility and strength can help manage symptoms and improve hand function.
Regular monitoring: Tracking disease progression through regular check-ups with healthcare providers is crucial to intervene promptly and adjust treatment plans as needed.
Early intervention: Addressing Dupuytren's disease early may slow its progression and improve treatment outcomes, emphasizing the importance of early diagnosis and intervention.
Living with Dupuytren's disease
Coping strategies for daily activities: Implementing adaptive strategies and modifying activities to accommodate changes in hand function can enhance independence and quality of life.
Adaptive tools and techniques: Using specialized tools and techniques designed for tasks like grasping objects or performing daily activities can facilitate easier and more comfortable living with the condition.
Emotional and psychological aspects: Addressing the emotional impact of living with Dupuytren's disease, including stress management and seeking support from healthcare professionals or support groups, is essential.
Support groups and resources: Connecting with support groups and accessing reliable resources can provide valuable information, emotional support, and practical advice for managing Dupuytren's disease.
Research and future treatments
Current studies: Ongoing research into Dupuytren's disease aims to advance understanding of its causes, progression, and treatment options through clinical trials and studies.
Emerging therapies: Investigational treatments such as stem cell therapies and new medications show promise in potentially offering alternative or complementary approaches to managing Dupuytren's disease.
Potential future directions: Exploring novel treatment modalities and advancements in biotechnology may pave the way for more effective and personalized treatment options in the future.
When to seek professional help
Signs for medical evaluation: Symptoms indicating the need for evaluation include the presence of nodules or cords in the palm, difficulty with hand movements, or noticeable changes in hand function.
Choosing between specialists: Consulting with a physiotherapist can be beneficial for managing hand function and rehabilitation, while other specialists such as orthopedic surgeons may be necessary for surgical interventions.
First appointment expectations: During the initial appointment, patients can expect a comprehensive evaluation of symptoms, medical history review, and discussion of treatment options tailored to their specific needs.
Importance of follow-ups: Regular follow-up appointments are essential for monitoring disease progression, adjusting treatment plans, and ensuring optimal management of Dupuytren's disease.
Conclusion
In conclusion, understanding and addressing Dupuytren's disease early can significantly impact treatment outcomes and quality of life. Emphasizing the importance of early detection and intervention, readers are encouraged to consult healthcare professionals for personalized care and support in managing Dupuytren's disease effectively.
References:
Gudmundsson, K. G., Arngrimsson, R., & Sigfusson, N. (2019). Epidemiology of Dupuytren's disease: Clinical, serological, and social assessment. Journal of Hand Surgery (European Volume), 44(6), 566-570. https://doi.org/10.1177/1753193419838765
Rayan, G. M., & Murray, D. (2007). Dupuytren's disease: Anatomy, pathology, presentation, and treatment. Journal of Bone and Joint Surgery (American Volume), 89(1), 189-198. https://doi.org/10.2106/JBJS.F.01168
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.