Dupuytren’s Contracture Surgery Auckland

Dupuytren’s contracture is a condition affecting the connective tissue beneath the skin of the palm and fingers.
Dupuytren’s contracture (or Dupuytren’s disease) results in a fixed flexion contracture  of the hand due to thickening of some of the tissues in the hand resulting in the fingers bending towards the palm and cannot be fully extended (straightened). It is an inherited proliferative connective tissue disorder that involves the hand’s palmar fascia (layer of tissue within the palm of the hand)

The ring and little are the fingers most commonly affected. Dupuytren’s contracture progresses slowly and is often accompanied by some aching and itching. In patients with this condition, the palmar fascia thickens and shortens so that the tendons connected to the fingers cannot move freely.  The incidence of Dupuytren’s contracture increases after age 40; at this age, men are affected more often than women. Beyond 80 the gender distribution is about even

Symptoms

Possible signs include:

Thickened tissue in the palm
Nodules
Tight cords beneath the skin
Increasing finger flexion
Difficulty placing the hand flat
Difficulty with everyday activities

The condition can progress gradually over years.

Dupuytren’s contracture decreases patients’ ability to hold objects. Patients often report pain, aching and itching. Dupuytren’s disease often starts with nodules in the palm of the hand and it can extend to cause a contracture in a finger.

Risk Factors

Dupuytren’s contracture is a non-specific affliction, but primarily affects:

People of Scandanavian or Northern European ancestry, it has been called the “Viking disease” or “Celtic hand”, though it is also widespread in some Mediterranean countries (e.g., Spain and Bosnia) and in Japan.

Men rather than women (men are ten times as likely to develop the condition).

People over the age of 40

People with a family history (60% to 70% of those afflicted have a genetic predisposition to Dupuytren’s contracture).

Causes

The cause of Dupuytren’s contracture is unproven but suspected to include trauma, diabetes, alcoholism, epilepsy therapy with phenytoin, and liver disease. No proven evidence links hand injuries or specific occupational exposures to a higher risk of developing Dupuytren’s. Some speculation links the condition or its onset may be triggered by, physical trauma such as sustained manual labor or over-exertion of the hands.

Assessment

A full assessment of your affected hand and suitability for treatment will be performed by Dr Stanley Loo at Auckland Plastic Surgery Group prior to any treatment.

The Tabletop Test

One simple assessment is the tabletop test.

You attempt to place your palm and fingers flat against a table.

If the affected hand cannot lie flat because of contracture, further assessment may be appropriate.

The current practice uses this assessment as part of determining treatment suitability.

When Is Treatment Required?

Treatment is generally considered when contracture begins to interfere with hand function.

The decision depends on:

Degree of contracture
Which fingers are involved
Joint involvement
Functional impairment
Progression
Overall health

Treatment is indicated when the so-called table top test is positive. With this test, the patient places his hand on a table. If the hand lies completely flat on the table, the test is considered negative. If the hand cannot be placed completely flat on the table, leaving a space between the table and a part of the hand as big as the diameter of a ballpoint pen the test is considered positive and surgery or other treatment may be indicated. Additionally, finger joints may become fixed and rigid.