Dupuytren contracture

Dupuytren contracture surgery in Montreal

The base of your thumb, your knuckles, second joint and top joint of your fingers  are common sites for hand arthritis. Osteoarthritis, rheumatoid arthritis and psoriatic arthritis are common types.

What is Dupuytren contracture?

Dupuytren contracture (also called Dupuytren disease) is an abnormal thickening of the skin in the palm of your hand at the base of your fingers. This thickened area may develop into a hard lump or thick band. Over time, it can cause one or more fingers to curl (contract), or pull sideways or in toward your palm.

The ring and little fingers are most commonly affected. In many cases, it affects both hands. Rarely, feet may also be affected.

 

Facts you should know about a Dupuytren’s contracture

  • Dupuytren’s contracture can prevent full extension of the affected finger.
  • Dupuytren’s contracture can prevent full extension of the affected finger.
  • A Dupuytren’s contracture is a localized scar tissue formation in the palm.
  • The precise cause of a Dupuytren’s contracture is not known.
  • A Dupuytren’s contracture is sometimes inherited.
  • A Dupuytren’s contracture can limit extension of the affected finger.

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Who is at risk for Dupuytren’s contracture?

You may be at greater risk for Dupuytren’s contracture if you:

  • Are older. The condition usually starts in middle age.
  • Are male. It is more common in men than women.
  • Have a Scandinavian or Northern European background. It is most common in people whose families come from these regions.
  • Have a family history. The condition is often found in families, so it may be inherited.
  • Take seizure medicine. It is linked with some medicines used to treat epileptic seizures.
  • Smoke or abuse alcohol
  • Have diabetes

 

Causes

Dupuytren contracture is believed to run in families (be hereditary). The exact cause is not known.

It may be linked to cigarette smoking, alcoholism, diabetes, nutritional deficiencies, or medicines used to treat seizures.

Signs and Symptoms

A Dupuytren’s contracture initially may cause only a minor painless lump in the palm of the hand near the base of the finger(s). A Dupuytren’s contracture most commonly affects the ring (fourth) finger and little finger, but it can affect any finger. A Dupuytren’s contracture can also affect one or both hands.

As a Dupuytren’s contracture progresses, it can lead to an inability to fully extend the affected finger from the flexed position. This can result in a loss of normal grasping.

Common symptoms may include:

Not being able to lay your hand flat on a table, palm down (called the tabletop test)
One or more small, sore lumps (nodules) in the palm. Over time, the soreness usually goes away.

 

  • The nodules may thicken and contract or tighten. This can cause thick bands of tissue under the skin in the palm of the hand.
  • Pits or grooves in the skin compressed by the contracted finger. These areas can become very sore and can lead to skin loss if they don’t heal well.
  • Fingers are pulled forward
  • Your hand is not able to work as well
  • The symptoms of Dupuytren contracture may look like other health problems. Always see your healthcare provider for a diagnosis.

Diagnosing Arthritis in Hands

Diagnosing hand arthritis involves an evaluation and tests. Your doctor will check the joints in your hand for signs of OA.

Signs include:

  • hand joint tenderness
  • swelling
  • deformity
  • limited range of motion

In some cases, your doctor will also order an X-ray to look for cartilage loss and other signs of damage. This can indicate arthritis of the hand and that they should look for potential bone spurs and erosions.

Symptoms of hand Osteoarthritis can be similar to other joint conditions. Your doctor may also order blood tests, especially to exclude other types of arthritis like rheumatoid arthritis.

Treatment for Arthritis in Hands

If nonsurgical treatments no longer provide relief and the cartilage at the ends of your bones has worn away, surgery may be an option. Surgical treatment for hand arthritis includes fusing the bones on the sides of the arthritic joint together, or reconstructing the joints.

There are several approaches:

Joint fusion (arthrodesis): This surgery uses a plate and screws to keep the bones of your joint together. You’ll have a more stable, pain-free joint, but will have limited flexibility and movement.

Joint replacement (arthroplasty): Similar to other joint replacements, surgeons use an artificial implant made of plastic, ceramics, silicone or metals to replace your damaged joint. Keep in mind that hinged finger implants don’t mimic normal finger movement.

Tendon transfer: Tendons connect muscles to bones. The tendons that control your fingers attach to muscles in your palm and forearm. Ongoing inflammation from arthritis can cause tendons to rupture. If this happens, a portion of a healthy tendon can be used to restore your hand function.

You and your surgeon will discuss which surgical approach might be best for your hand considering your age, activity level, the joint(s) affected and the amount of pain and deformity you’re experiencing.

     

    What should I expect after hand surgery?

    You may need a cast or splint after surgery to protect your hand while it’s healing. Your surgeon may refer you to a hand therapist. Your provider will likely prescribe pain medication to take for a limited amount of time to reduce discomfort.

    It is our goal at Station L to ensure that your entire experience from the initial consultation to your recovery is as positive and comfortable as possible. Your plastic surgeon and surgical coordinator will go over your post-operative instructions and recovery with you as it is essential for your Hand surgery results that you follow care instructions closely.

    • Keep your dressings clean and dry: until your doctor says otherwise. If you need to bathe or shower, cover the dressings with a plastic bag taped securely at the opening to prevent getting wet, and keep the area out of the direct stream of water. If your dressing becomes wet, call your doctor immediately. DO NOT remove or modify the dressing unless instructed by your doctor.
    • Elevate your arm and hand: To prevent and minimize swelling and pain, raise the hand/arm above the level of the heart for 3-5 days. When indicated, you will be given a sling or blue Carter pillow. The hand may be held down only for brief periods of time. Continue to elevate the hand if swelling or pain persists after 3-5 days. Move your unaffected joints on the surgical side as much as possible to help with swelling and prevent stiffness. For example, if you had surgery on your thumb, then move your shoulder, elbow, wrist and other fingers.

    Part of our process at Station L is making sure that you have all the information you need to make informed decisions and feel guided through the entire process. Our concept is for you to have a five star experience, and our goal is for you to have the best possible outcomes and least possible complications.Proper follow-up care is key for a successful recovery. Be sure to go to all your follow-up appointments as directed and call the office if you have any issues or questions.

    Our office is always available for questions via email or text message should more questions arise.

       

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