Dupuytren's contracture

Dupuytren's contracture is a medical condition characterized by gradual contraction of the fascia (the tissue surrounding the tendons in the palm of the hand) and binding of the fingers of the hand, usually the fourth and fifth fingers. This pathology is named after the French surgeon Guillaume Dupuytren, who first described it in 1831.

Symptoms of Dupuytren's contracture include the following:

1. Formation of thickenings and nodules in the palm of the hand, most commonly on the palm side of the hand.
2. Gradual contraction of one or more fingers, which can make it difficult to straighten the fingers completely.
3. Limitation of mobility of the fingers, especially the fourth and fifth fingers.

Dupuytren's contracture usually develops slowly and can affect quality of life by limiting the ability to perform everyday tasks such as squeezing objects or holding objects in the hands. The cause of this condition is not always known, but it is thought that genetic factors and certain other risk factors may contribute to its development.

Treatment for Dupuytren's contracture may include watch and wait, physical therapy, injections of medications, and in some cases, surgery to remove the contracted tissue and restore finger mobility. Treatment depends on the extent and severity of the condition. If you suspect Dupuytren's contracture, it is important to see a physician or surgeon to evaluate and determine the best treatment option.

Causes of the dupuytren's contractures

The causes of Dupuytren's contracture are not yet fully understood, but there are a number of factors that may increase the risk of developing this condition. It is important to note that Dupuytren's contracture is more likely to develop in people over the age of 50 and is more common in men than women. Here are some of the possible risk factors and suspected causes:

1. Genetics: Familial and hereditary predisposition is considered a major risk factor. If your close relatives have had Dupuytren's contracture, you may have a higher risk of developing this condition.
2. Race: Dupuytren's contracture is more common in people of European descent, especially northern Europeans.
3. Gender: Men are more susceptible to Dupuytren's contracture than women.
4. Disease-related conditions: Certain medical conditions such as diabetes, alcoholic liver disease, and epilepsy may increase the risk of developing Dupuytren's contracture.
5. Metabolic disorders: Certain metabolic disorders, such as diabetes mellitus, may increase the risk of developing Dupuytren's contracture.
6. Aging: Dupuytren's contracture is more likely to develop in older adults, which may be due to the natural aging process and tissue changes.

Despite these risk factors, the specific mechanisms leading to the development of Dupuytren's contracture are still the subject of research.

Pathogenesis

The pathogenesis of Dupuytren's contracture, although not fully understood, has been investigated to some extent. The key pathologic process that occurs in Dupuytren's contracture involves changes in the fascia (the tissue surrounding the tendons) of the palm and fingers of the hand. Here are some of the suspected mechanisms that may play a role in the development of Dupuytren's contracture:

1. Fibrosis (connective tissue formation): The main characteristic of Dupuytren's contracture is the formation of fibrosis in the fascia of the palm. This fibrosis is a process in which normal connective tissue is replaced by denser and harder connective tissue (collagen). This leads to knot formation and tissue contraction, which causes the fingers to bend.
2. Genetics: Genetics plays an important role in the development of Dupuytren's contracture. Many studies indicate a familial predisposition to this condition. Hereditary genes may be associated with a higher risk of developing fibrosis and contracture.
3. Inflammation: Inflammation can also accompany Dupuytren's contracture. Inflammation can promote the formation of denser connective tissue and accelerate the development of the contracture.
4. Growth factor secretion: Some studies indicate increased secretion of growth factors, such as transforming growth factor beta (TGF-β), in the palmar fascia in Dupuytren's contracture. These factors may promote connective tissue growth.
5. External factors: Several external factors, such as trauma or microtrauma, may be associated with the development of Dupuytren's contracture. However, they probably play a role in conjunction with genetic and intrinsic factors.

All of these mechanisms may interact with each other, and their exact impact on the development of Dupuytren's contracture requires further research.

Symptoms of the dupuytren's contractures

The main symptom of this contracture is a gradual shrinking of the ligaments and limited mobility in the fingers. Symptoms of Dupuytren's contracture may include:

1. Nodes and thickenings: At the beginning of Dupuytren's contracture, nodes and thickenings may appear on the palm of the hand, which usually do not cause pain. These nodules may be located in the palm area, usually closer to the base of the fingers.
2. Gradual contraction of the fingers: As the condition progresses, the ligaments begin to shrink, resulting in limited mobility in the fingers. Dupuytren's contracture usually affects the fourth and fifth fingers, but in some cases it can spread to other fingers.
3. Difficulty in extending the fingers: Gradually, extending the fingers becomes more difficult due to the contraction of the ligaments. In the final stages of contracture, the fingers may be bent into the palm and become completely immobile.
4. Pain and discomfort: In most patients, Dupuytren's contracture is not painful. However, some may experience discomfort or discomfort, especially when trying to extend bent fingers.

The symptoms of Dupuytren's contracture can appear gradually and can vary greatly depending on the extent of the condition.

Dupuytren's contracture is not usually accompanied by pain, especially in the early stages of the disease. The main symptom of Dupuytren's contracture is limited mobility in the fingers, mainly in the fourth and fifth fingers, as well as the formation of knots and thickenings in the palm area.

Pain may occur in rare cases if the contracture has reached a stage where the ligaments and tissues are severely strained due to contraction and restrict blood supply and nerve innervation. However, pain is not usually the primary symptom of Dupuytren's contracture, and if it occurs, it may be mild to moderate.

If you are experiencing pain or discomfort due to Dupuytren's contracture, it is important to see your doctor or orthopedist. Your doctor will be able to evaluate the condition of your hand, perform additional tests, and consider possible treatments to relieve pain and improve finger mobility.

Stages

There are several systems for classifying degrees of Dupuytren's contracture, but one of the most widely used is the CBC classification (Cheng-Waskowski-Slegel):

1. Grade I:

   • In this stage, Dupuytren's contracture may manifest as small knots and tight bumps in the palm of the hand.
   • Patients usually do not experience severe limitations in finger mobility.

2. Middle Grade (Grade II):

   • In this stage, the contracture becomes more prominent and significant.
   • Patients may experience limited mobility in one or more fingers, usually the fourth and/or fifth fingers.

3. Expressed Grade (Grade III):

   • The contracture becomes more severe, significantly limiting finger mobility.
   • Finger flexion becomes more prominent and patients may have difficulty performing common tasks such as squeezing objects.

4. Severe Grade IV:

   • In this stage, Dupuytren's contracture is usually accompanied by significant contraction of the fingers and severe limitation of mobility.
   • The fingers may be completely bent into the palm of the hand, greatly limiting the functionality of the hand.

Complications and consequences

Various complications and consequences can occur in the case of Dupuytren's contracture:

1. Limitation of mobility: The main consequence of Dupuytren's contracture is limited mobility in the fingers, especially the fourth and fifth fingers. This can make it difficult to perform everyday tasks such as grasping objects or performing fine manipulation.
2. Pain and discomfort: Some patients may experience soreness in the area of the thickening and in the joints affected by the contracture.
3. Deformities: The long-term presence of Dupuytren's contracture can lead to finger deformities that affect the appearance of the hand.
4. Limitations in daily life: Contractures can make it difficult to perform everyday activities such as dressing, grooming, and occupational tasks.
5. Secondary complications: In some cases, if Dupuytren's contracture is left untreated, secondary complications such as infections, ulcer formation and hyperkeratosis (increased formation of horn cells on the skin) can develop.

Diagnostics of the dupuytren's contractures

If you suspect Dupuytren's contracture or have symptoms, you should see your doctor for evaluation and diagnosis. The first step may be a visit to your family doctor or general practitioner, who can assess the condition and refer you to a specialist if necessary. Depending on the degree and severity of the contracture, the following specialists may be included in the treatment process:

1. Orthopedist(orthopedic surgeon): Orth opedists specialize in treating diseases and disorders related to the musculoskeletal system, including Dupuytren's contracture. They may offer a variety of treatments, including surgery.
2. Surgeon: In cases of more severe or advanced degrees of contracture, surgery may be necessary to remove the knots and restore finger mobility. Surgeons who specialize in hand surgery are called hand surgeons.
3. Physical therapist: Physical therapists can help with rehabilitation after surgery or other procedures. They develop individualized exercise programs to restore mobility and strength to the arm.
4. Rheumatologist: Rheumatologists specialize in treating rheumatic and inflammatory conditions that may be associated with Dupuytren's contracture. They may perform additional tests and investigations to clarify the diagnosis.
5. Geneticist: If there is a familial predisposition to Dupuytren's contracture, a geneticist can provide counseling and assess the risk of other family members developing the condition.

Diagnosis of Dupuytren's contracture usually begins with a clinical examination of the patient and review of the patient's medical history. The following methods may be used to confirm the diagnosis:

1. Clinical Examination: The physician performs an external examination of the patient's hands and notes the presence of thickening or nodules in the palms and fingers. Dupuytren's contracture most commonly affects the four and five fingers, causing them to bend and reduce mobility.
2. Palpation: The doctor can feel the thickening and nodules characteristic of Dupuytren's contracture in the palms and fingers.
3. Functional tests: The patient may be given certain tests to assess hand mobility and functionality. These tests may include measuring the length of the finger flexors and determining the degree of limitation of movement.
4. Instrumental examinations: In some cases, ultrasound (ultrasound) may be required to examine changes in the tissues of the hand in more detail. However, ultrasound is not always necessary to make a diagnosis of Dupuytren's contracture.
5. Magnetic resonance imaging (MRI): In rare cases, an MRI may be required to examine the structures of the hand in more detail, especially if there are complex or unusual contracture cases.

To establish a diagnosis of Dupuytren's contracture, it is important to see a qualified physician, usually a surgeon or rheumatologist, who will perform the necessary examination and determine treatment measures, if necessary.

Differential diagnosis

Differential diagnosis of Dupuytren's contracture involves identifying and distinguishing this condition from other diseases or disorders that may cause similar symptoms in the hands. Here are some of the most common conditions that may be similar to Dupuytren's contracture:

1. Ledderhose disease: This condition is similar to Dupuytren's contracture, but affects the aponeurosis of the foot, causing nodule formation and tissue contraction. It can be differentiated based on location - Dupuytren's contracture usually manifests in the palm and fingers of the hand.
2. Frozen shoulder periarthritis: This condition is characterized by limited mobility of the shoulder joint and pain in the area. It can cause restriction of arm movement, but it is different from Dupuytren's contracture, which predominantly affects the fingers and palm.
3. Arthritis: Different types of arthritis can cause pain and limitation of movement in the joints. Differentiate arthritis from Dupuytren's contracture by clinical examination, nodule formation, and the presence of finger contraction.
4. Tendovaginitis (Tendonitis): This is an inflammation of the tendons and can cause pain and restriction of movement in the arm. However, tendovaginitis does not usually lead to knot formation and tissue contraction like Dupuytren's contracture.

Nott's disease and Dupuytren's contracture are two different medical conditions that can affect the hand but have different causes, symptoms and characteristics. Here are their main differences:

Nott's disease:

1. Origin: Nott's disease, also known as "disease of the outside of the elbow," is associated with inflammation or irritation of the nerve trunk that runs along the outside of the elbow. It is a nerve disorder.
2. Symptoms: The main symptom of Nott's disease is pain, numbness and/or weakness in the outer elbow and forearm. Patients may experience tingling, burning, and discomfort in this area.
3. Diagnosis: The diagnosis of Nott's disease is usually made based on symptoms, clinical examination, and possibly electromyography (the study of electrical activity of muscles and nerves).

Dupuytren's contracture:

1. Origin: Dupuytren's contracture is a condition in which the fascia (ligaments) in the palm of the hand and fingers thicken and contract, resulting in limited mobility in the fingers. The cause of this condition is not fully known, but genetic factors may play a role.
2. Symptoms: The main symptom of Dupuytren's contracture is the appearance of nodules and thickenings in the palm and fingers, as well as a gradual reduction in the mobility of the fingers, especially the fourth and fifth fingers.
3. Diagnosis: The diagnosis of Dupuytren's contracture is usually made based on clinical examination and assessment of the degree of limitation of finger mobility.

Thus, the main differences between Nott's disease and Dupuytren's contracture lie in the origin, symptoms, and nature of the changes in the hand.

Treatment of the dupuytren's contractures

Treatment for Dupuytren's contracture may involve several steps, depending on the extent of the condition and the treatment method chosen. Here are the general steps in the treatment of Dupuytren's contracture:

1. Diagnosis and evaluation: The doctor performs an examination and diagnosis to determine the extent of the contracture, its prevalence and its effect on finger mobility. This helps in selecting the most appropriate treatment method.
2. Conservative treatment (if necessary):
   • Injections: If the contracture is in the early stages, the doctor may consider injections of medications, such as collagenase, to break down the ligaments and improve mobility.
   • Physical therapy: Physical therapy exercises and stretching may be recommended to maintain mobility.
3. Follow-up: The doctor may decide to monitor the development of the contracture and take action only when necessary, especially in the early stages.
4. Surgical treatment (if necessary):
   • Fasciectomy or fasciotomy: These are surgical procedures in which the surgeon removes or makes an incision in the affected ligaments to restore finger mobility.
   • Radial disintegration: In some cases, radio wave energy is used to destroy the ligament.
5. Rehabilitation and physical therapy after surgery: After surgery, rehabilitation and physical therapy may be required to restore function and mobility.
6. Follow-up and monitoring: After treatment, it is important to have regular follow-up and monitoring of the condition to detect possible recurrences or changes.

Each patient is unique and a treatment plan should be tailored to meet their individual needs and disease characteristics. It is important to discuss all available treatments and possible risks with your doctor to make an informed decision about the best approach to treating Dupuytren's contracture.

Drug treatment

Medications cannot completely cure Dupuytren's contracture, but they can be used to manage symptoms and reduce pain and inflammation. Here are some drug treatments for Dupuytren's contracture:

1. Corticosteroid injections: Corticosteroid injections can be used to reduce inflammation and pain in the area of the contracture. However, they usually provide temporary relief and do not affect the contracture itself.
2. Collagen injections: Collagen injections can be used to attempt to break up thickening and improve mobility. This method can also provide temporary relief.
3. Hyaluronidase injections: This method involves injections of hyaluronidase, an enzyme that can help break down the thickening in Dupuytren's contracture. This can be an effective treatment for some patients.
4. Medications to reduce the risk of recurrence: After surgical treatment of Dupuytren's contracture, certain medications may be prescribed to reduce the risk of recurrence.
5. Anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce inflammation and pain in the area of the contracture.

Treatment of Dupuytren's contracture should be individualized, and the choice of method depends on the degree and characteristics of the contracture and the doctor's recommendations. In cases of severe contractures, when other methods are not effective, surgery may be required to remove the thickening and restore mobility to the hand. It is important to get a consultation with your doctor to determine the best treatment plan for your situation.

Some of the medications and techniques used include:

1. Lidase (hyaluronidase): Lidase is sometimes used to treat Dupuytren's contracture. It can be injected into the knots or tissues to break down hyaluronic acid, which can improve finger mobility. The procedure may be performed by a physician. The effectiveness of this technique can vary, and it is not always the primary treatment choice.
2. Diprospan (Diprolens, Diplangen, Diprinosyn, etc.): These are medications that can be used to inject into Dupuytren's contracture nodes to reduce inflammation and decrease the size of the nodes. The use of these injections should be administered by a physician and depending on the specific situation.
3. Ointments: There are several ointments and creams that can be used to soften areas of contracture and alleviate discomfort. However, ointments usually cannot completely eliminate the contracture and are often used in combination with other treatments.

Ointments cannot treat Dupuytren's contracture directly, as this chronic condition involves thickening of the tendons and connective tissue in the fingers of the hand and often requires physical therapy, injections, or surgery. However, ointments can be used to relieve symptoms such as pain and inflammation. Your doctor may prescribe the following ointments:

1. An ointment with some sort of antibiotic or anti-inflammatory component to reduce inflammation and pain in the area of the contracture.
2. An ointment with a local anesthetic to reduce pain.
3. Ointments with anti-inflammatory NSAIDs such as diclofenac or ibuprofen. These can help reduce inflammation and pain.
4. Ointment with capsaicin may be recommended to relieve pain and discomfort.
5. Contractubex is a medication used to treat scars and burns. In some cases, it may be used after surgical removal of Dupuytren's contracture knots to reduce the risk of scarring.

It is important to discuss with your doctor or rheumatologist which ointment to use so that it meets your needs and does not cause allergic reactions or side effects. You should not use ointments without consulting your doctor, especially if you already have a diagnosed Dupuytren's contracture.

Physiotherapy

Physical therapy can be part of a comprehensive treatment for Dupuytren's contracture and can help improve finger and hand mobility. Here are some physical therapy techniques that can be applied:

1. Stretches: Your physical therapist can teach you to perform stretches and exercises to improve mobility in your fingers and flexor tendons. Regular stretching can help develop more flexible tissue and reduce contractures.
2. Muscle strengthening: Strong arm muscles can help compensate for limited joint mobility. A physical therapist may suggest exercises to strengthen the muscles in the hand and forearm.
3. Massage: Massage therapy can help improve circulation, reduce tissue tension and reduce soreness. Massage should be performed by an experienced massage therapist familiar with the treatment of Dupuytren's contracture.
4. Heat and cold therapy: Applying heat and cold can help reduce inflammation and relieve pain.
5. Devices and adaptive aids: The physical therapist may recommend the use of special devices and bracelets that help maintain proper hand and finger positioning.
6. Hand Care Instructions: Your physical therapist can give you advice on how to care for your hand and warn you against activities that may aggravate the contracture.

Treatment of Dupuytren's contracture may include various physical therapy and physical rehabilitation techniques, including electrophoresis, phonophoresis, paraffin and compresses. However, the effectiveness of these methods may vary from patient to patient and the decision to use them should be made by the physician based on the individual needs and characteristics of the patient.

1. Electrophoresis: Electrophoresis is a physical therapy technique that uses a direct electric current to deliver medication through the skin to the area of the contracture. This can help soften the tissue and reduce inflammation. The use of specific medications and electrophoresis parameters will depend on your doctor's recommendations.
2. Phonophoresis: Phonophoresis is a technique that uses ultrasound to deliver medication through the skin. This method can help improve the penetration of medications into deep tissues and reduce inflammation.
3. Paraffin therapy: Paraffin therapy involves coating the contracture area with a paraffin mixture and making a compress. Paraffin helps to relax the muscles, improve circulation and reduce soreness.
4. Compresses: Heat compresses can also be used to improve joint mobility and reduce pain. However, compresses should be used with caution to avoid burns or injury.

Gymnastics and massage

Gymnastics and massage can be useful complementary methods in the management of Dupuytren's contracture, especially in the initial stages and after surgery to restore finger mobility. However, it is important to note that these methods may not fully resolve the problem and should be used under the guidance of a physician or physical therapist. Here are some recommendations for exercises and massage for Dupuytren's contracture:

Gymnastics:

1. Finger stretching: Try stretching and extending the fingers of your palm as wide as possible and hold your fingers in this position for a few seconds. Repeat the exercise several times throughout the day.
2. Compression and relaxation: The fingers can be compressed and relaxed several times a day. This exercise helps to improve finger mobility.
3. Palm stretch: Try to gently stretch the palm of your hand, trying to spread your fingers as far apart as possible. Hold the stretch for a few seconds and repeat the exercise.

Massage:

1. Gentle Massage: A light palm and finger massage can help improve circulation and relax the tissues. Use gentle and circular motions to massage.
2. Massaging areas with knots: If you have knots in the palm of your hand, you can gently massage these areas, trying to soften their tissues.

Folk remedies and home methods

Dupuytren's contracture is a medical condition that usually requires professional treatment, especially in advanced cases. Despite this, there are several home measures and folk remedies that can help improve the patient's condition and reduce the symptoms of Dupuytren's contracture, but they cannot cure the problem completely. It is important to discuss any changes in the treatment regimen with your doctor before using it.

Folk remedies and home methods may include:

1. Warm compresses: Applying warm compresses to the affected area of the palm and fingers can help relax the muscles and ligaments, which may temporarily improve mobility. It is important to make sure that the compresses are not too hot to avoid burns.
2. Exercise: Performing regular exercises and stretches for your fingers and palm can help maintain mobility and reduce contractures. Your joints should be able to perform these exercises without pain or discomfort.
3. Massage: Gentle finger and palm massages can help improve circulation and relax muscles. Ask a professional massage therapist or learn massage techniques for self-massage.
4. Use of Oils and Creams: Some people report positive results from using oils and creams to gently moisturize and care for the skin of the palm and fingers.
5. Maintaining a healthydiet and lifestyle: Maintaining a healthy lifestyle and proper nutrition can promote overall health and keep tissues in good shape.
6. Use of special assistive devices: In some cases, special devices, such as special hand exercisers, can help improve mobility.

Needle aponeurotomy.

Needle aponeurotomy (or needle aponeurotomy) is a procedure performed to treat Dupuytren's contracture when the condition is still in its early stages and the nodules or tissue contractions are small and soft. This procedure can be an alternative to surgical intervention and is usually performed on an outpatient basis without the need for a hospital stay.

The needle aponeurotomy procedure involves the following steps:

1. Patient preparation: The patient is given local anesthesia to ensure comfort during the procedure. This local anesthetic is usually administered to the area where the Dupuytren's contracture nodes are located.
2. Needle use: A medical needle is inserted into the area of the contracture junction. The doctor then uses this needle to break or tear the contracted connective tissue (aponeurosis) inside the palm of the hand.
3. Finger Manipulation: During the procedure, the doctor may also perform finger manipulation to loosen and increase finger mobility.
4. Completion of the procedure: Once the desired correction of the node and aponeurosis has been achieved, the procedure is completed.

After needle aponeurotomy, the patient may be treated with physical therapy and advised to wear a special splint or bandage for support and to prevent the contracture from returning. Recovery from this procedure is usually quicker than after surgical intervention and allows the patient to return to normal activities quickly.

It is important to note that the effectiveness of needle aponeurotomy may be temporary and the contracture may return in the future. Surgery remains a more durable treatment option, especially in the more advanced stages of Dupuytren's contracture. Patients should discuss with their physician the most appropriate method of treatment given the extent and nature of their condition.

Surgery for Dupuytren's contracture.

Surgery is one of the treatments for Dupuytren's contracture, especially when the condition has advanced to the point where it significantly limits finger mobility and causes discomfort. The surgery to remove Dupuytren's contracture is called a fasciectomy. Here is an overview of the process:

1. Pre-operativepreparation: Prior to surgery, the doctor evaluates the patient and the area of the contracture. The risks and benefits of surgery are discussed.
2. Anesthesia: The surgery may be performed under local or general anesthesia depending on a variety of factors, including the patient's wishes and the complexity of the surgery.
3. Access to the contracture: The surgeon makes a small incision in the palm of the hand in the area of the contracture to gain access to the affected ligaments and tissues.
4. Contracture removal: The surgeon removes or makes incisions in the ligaments and tissues that are causing the contracture. This allows the mobility of the fingers to be restored.
5. Wound closure: After the contracture is removed, the surgeon closes the wound with sutures or other closure methods.
6. Rehabilitation: After surgery, the patient may be prescribed physical therapy and exercises to restore mobility and strength in the arm. This helps prevent recurrence of the contracture.
7. Postoperative care: The patient should follow the doctor's instructions for wound care and restrictions on movement for the first time after surgery.

Dupuytren's contracture surgery usually has good results, and most patients experience significant improvement in finger mobility. However, as with any surgery, it is not without risks and rehabilitation can take some time.

Recovery from surgery

After Dupuytren's contracture surgery, it is important to make a proper recovery in order to regain functionality of the hand. Here is a general overview of what you can expect after surgery and what measures will aid recovery:

1. First days after surgery: After surgery, the hand will be dialated into a plaster cast or removable bandage. During this period, it is important to avoid strain on the arm and to follow your surgeon's instructions regarding arm care and rest.
2. Physical Therapy: After the cast or bandage has been removed, your doctor or physical therapist may prescribe physical therapy. This may include various exercises to restore mobility to the fingers and palm. Physical therapy can help strengthen muscles and ligaments.
3. Suture removal: If you have stitches placed after surgery, they will be removed at a specific time specified by your surgeon.
4. Exercise avoidance: It is important to avoid lifting heavy weights and heavy loads on the arm for several weeks after surgery.
5. Rehabilitation Exercises: Continue to perform the recommended rehabilitation exercises to regain mobility and strength in your arm.
6. Follow-up with your doctor: See your doctor regularly to assess your recovery progress and adjust treatment as needed.
7. Monitoring for residual contracture: In some cases, residual contracture may remain after surgery. The doctor will monitor this and may recommend additional procedures if necessary.

Recovery time after Dupuytren's contracture surgery can vary depending on the complexity of the surgery and the individual patient. It is important to follow the instructions of your physician and physical therapist to maximize the restoration of mobility and functionality of the hand.

Clinical Guidelines

Dupuytren's contracture is a chronic condition characterized by thickening and contraction of the connective tissue (aponeurosis) in the palm and fingers, which can cause limited finger mobility. Here are some general clinical guidelines for managing Dupuytren's contracture:

1. Consult your doctor: If you have symptoms that suggest Dupuytren's contracture, see your doctor for diagnosis and consultation. He or she will be able to evaluate the condition and recommend appropriate treatment.
2. Contracture Evaluation: The doctor will evaluate the severity of the contracture to determine the best method of treatment. The contracture may be graded as Grade I (initial), Grade II (moderate), or Grade III (severe).
3. Treatment: Treatment for Dupuytren's contracture may include:
   • Observation and waiting, especially in the initial stages.
   • Needle aponeurotomy or injections of medications (such as lidase or dipropane) into the contracture nodules.
   • Surgery to remove the knots and aponeurosis if the contracture has become severely limiting finger mobility.
4. Physical Therapy and Exercise: Physical therapy and specific exercises can help restore finger mobility after treatment or surgery.
5. Following your doctor's advice: It is important to follow your doctor's instructions and take recommended medications as needed. Keeping your appointments and seeing your doctor regularly will help control and manage your condition.
6. Prevention: Dupuytren's contracture often has a genetic predisposition. If you or your family has a history of Dupuytren's contracture, regular follow-up with your doctor and utilizing preventative methods can be important.
7. Self-care: Monitor the condition of your hands and fingers. If new nodules appear or symptoms worsen, consult a doctor.

Dupuytren's contracture is a chronic condition and managing it may require long-term efforts. Therefore, it is important to keep in touch with a medical professional and follow their recommendations for the best management of the condition.

Prevention

Dupuytren's contracture is a chronic condition that often has a genetic predisposition and can be difficult to prevent completely. However, there are some recommendations and measures that can help reduce the risk of developing this condition:

1. Risk Factor Management:

   • Smoking and alcohol consumption may increase the risk of developing Dupuytren's contracture. Therefore, reducing or stopping smoking and drinking alcohol in moderation may be beneficial.

2. Proper hand care:

   • Maintain good hand hygiene and skin care. This will help prevent irritation and potential damage.

3. Healthy diet and activity level:

   • Proper nutrition and physical activity can promote overall health and prevent a variety of conditions, including Dupuytren's contracture.

4. Genetic counseling:

   • If you have a family history of Dupuytren's contracture, a consultation with a genetic counselor can be helpful in understanding your individual risk and developing a monitoring and prevention plan.

5. Early medical attention:

   • If you experience the first symptoms of Dupuytren's contracture, such as thickening in your fingers or limited mobility, see your doctor as soon as possible. Early treatment can help prevent the condition from getting worse.

Forecast

The prognosis of Dupuytren's contracture can vary depending on several factors, including:

1. Degree of contracture: The earlier the diagnosis is made and treatment started, the better the prognosis. If the contracture is early and limited, there is a high probability that improvement can be achieved and mobility of the hand and fingers can be maintained.
2. Rate of progression: In some patients, Dupuytren's contracture may progress slowly, while in others it may progress more rapidly. Rapid progression can make treatment more difficult.
3. Degree of mobility limitation: If Dupuytren's contracture has resulted in severe mobility limitation of the hand and fingers, the prognosis may be less favorable. In such cases, surgical intervention may be required to restore functionality to the hand.
4. Treatment: Effective treatment can slow the progression of the contracture and improve the mobility of the hand. Treatment may include physical therapy, exercises, injections (such as collagen or botulinum toxin injections), and in some cases, surgical removal of the knots and tissue causing the contracture.
5. Associated Conditions: The presence of other medical conditions, such as diabetes or connective tissue disease, can affect the prognosis and treatment of Dupuytren's contracture.

Disability

Dupuytren's contracture can limit finger mobility and cause significant discomfort, but it does not always result in disability. The results of treatment and the degree of limitation depend on how advanced the condition is and how quickly therapy was initiated.

Treatment for Dupuytren's contracture may include physical therapy, use of special devices to stretch the fingers, injections of drugs such as Xiaflex collagenase, and surgery (fasciectomy) in which the thickened ligaments and tissue in the palm of the hand are removed.

If untreated or untreatable, Dupuytren's contracture can progress, limiting the mobility of the fingers. In cases of severe Dupuytren's contracture, where the fingers cannot be fully extended, adaptive aids may be required to make it easier to perform daily tasks.

The decision to award a disability depends on the degree of limitation that affects a person's ability to perform work and normal daily activities. It also depends on the legislation and standards in force in a particular country or region.

If Dupuytren's contracture is seriously affecting your ability to perform work or everyday tasks, it is important to discuss with medical professionals and Social Security about disability status and the benefits and support available to you.

Literature

Nasonov, E. L. Rheumatology / Edited by E. L. Nasonov, V. A. Nasonova - Moscow : GEOTAR-Media, 2010.