The palmer fascia is a thick tissue that lies above the tendons and below the skin of the hand. The fascia is attached both to the skin above and to structures below. The palmer fascia helps provide a tough, gripping surface for the hand and fingers.
What causes Dupuytren's contracture?
No one really knows what causes Dupuytren's contracture, but it is well known that it runs in families -- 60% to 70% of individuals have a family history of the condition. Other factors have been suspected for causing Dupuytren's contracture, such as trauma, diabetes, alcoholism, epilepsy, and liver disease, but there is no clear relationship.
The condition is most common in older (usually after age 40), men (more common than women), with North European ancestry (one group commonly cited is those with Viking ancestry).
There is evidence that trauma may contribute to development of Dupuytren's contracture. It has been investigated if specific traumatic events or a history of manual labor may contribute to this problem. Microscopically, there is evidence of bleeding within the affected tissues, evidence that trauma may contribute to this condition. That said, Dupuytren's is often seen in both hands, and found just as often in dominant and non-dominant hands -- evidence that this problem is not the result of repetitive trauma.
What should I expect if I have Dupuytren's contracture?
The first clinical signs of Dupuytren's contracture are usually small, painless nodules in the palm. The nodules may begin to coalesce and the skin becomes puckered. Eventually, in the later stages of disease, the skin and underlying fascia contracts, causing an impairment of hand and finger function. People with Dupuytren's contracture have fingers that are bent down towards their palm.
While all fingers can become involved, Dupuytren's contracture most commonly affects the ring and little fingers. The progression of Dupuytren's tends to be in rapid bursts, followed by periods of little change. Dupuytren's contracture is seldom painful, but can be a great nuisance. Dupuytren's is usually limited to involvement of the hand, but can also involve other parts of the body, most commonly the soles of the feet. About 5% of patients with Dupuytren's contracture also have a similar condition of the soles of the feet called Lederhose's disease.
Is there a difference between 'Dupuytren's contracture' and 'Dupuytren's disease'?
Not really. Most people, physicians included, use these terms interchangeably. Technically speaking, Dupuytren's disease refers to the proliferation of the cells that cause the formation of the nodules and contractures. Dupuytren's contracture is the result of this cell proliferation, and a common manifestation of Dupuytren's disease. Treatment of Dupuytren's contracture may be considered when the condition causes difficultly performing normal daily tasks.
Prognostic Factors for Dupuytren's Contracture
|Heredity||A history of this condition within your family is an indication that it will be more aggressive.|
|Sex||Dupuytren's usually begins later, and progresses more slowly in women.|
|Alcoholism or Epilepsy||These conditions are associated with Dupuytren's that is more aggressive, and more likely to recur.|
|Location of Disease||When in both hands, or when there is associated foot involvement, the progression tends to be more rapid.|
|Behavior of Disease||More aggressive Dupuytren's is more likely to recur after surgery and continue to be aggressive.|