07.10.2008

Fingers Bent Out of Shape?

For reasons little understood, some people develop a hand disorder in which the
fingers bend in towards the palm and cannot be straightened. The little or ring
fingers are most commonly affected, but any or all fingers can be involved.

A slow-progressing, usually painless disorder, Dupuytren's (pronounced De-PWEE-
trenz) contracture develops when the tissues under the skin of the palm
thicken, forming knots (nodes) and cords of tissue. When these cords shorten,
they pull one or more fingers into a bent position, which cannot be
straightened.

The disease usually begins with a palm nodule (can resemble a callus) that
develops at the base of the ring or little finger. Gradually a prominent cord
develops. Over time, the overlying skin puckers, dimples, and roughens. The
thick cords gradually contract, drawing the fingers into the palm. Sometimes,
they also draw adjacent fingers together.

Dupuytren's contracture can make it difficult to perform certain functions
using your hand. Fine activities such as writing are still possible, as long as
the thumb and index finger aren't affected. But as Dupuytren's contracture
(sometimes called Dupuytren's disease) progresses, it can limit your ability to
grasp large objects or to get your hand into narrow places.

Risk factors for Dupuytren's contracture

Progression of the condition is often erratic and arbitrary with no obvious
cause. There are however, a number of risk factors:

  • Age and sex (more common in males in their 50s and 60s)

  • Family history

  • Alcoholism and/or smoking (perhaps due to microscopic changes within blood
    vessels caused by smoking)

  • Diabetes

  • Epilepsy (possible association with anticonvulsant medications but this
    association remains controversial)

  • Hand trauma

Some researchers believe Dupuytren's contracture may be work-related in certain
cases, however studies are inconclusive. While some suggest that heavy manual
work and vibration exposure may be associated with Dupuytren's contracture,
other studies do not show this association.

Treatment options

For people who experience pain or have difficulty using the affected hand,
doctors have investigated a few possible treatments for Dupuytren's
contracture. These include medications, physical therapy, enzyme injections,
vitamin E, radiation or ultrasound therapy, steroid injection, or
collagenolytic agents. Some of these treatments have been more effective than
others, however none are scientifically proven.

Another option is a minimally invasive procedure called needle aponeurotomy.
The technique uses a needle to puncture and "break" the cord of tissue that's
contracting a finger, allowing the finger to be straightened again. It is
common for contractures to reoccur over time, requiring some people to have the
procedure repeated.

To date, the widely accepted treatment for confirmed cases is surgery to remove
the diseased fascia. By removing the tight cords and fascia, the tension on the
finger is released. Surgical complications such as injury to nerves or
arteries, infection, chronic pain, skin changes are a concern, however,
especially in patients with severe cases of the disease.


More info


AplusA-online.de - Source: Canadian Centre for Occupational Health and Safety