Dupuytren's contracture (palm scale): What you need to know

Dupuytren's contracture is a disease that causes small nodules, lumps, or bumps under the skin of the fingers and palms. The disease can make your fingers stuck. It usually affects the ring and little fingers and causes joints to be shorter than normal, curved and out of alignment.
This is a relatively common disease, characterized by hyperplasia of the palmar fascia and related structures causing the palmar fascia to contract and nodularly appear. The cause is unknown, but may have a genetic component and occurs primarily in men over the age of 50.
The incidence of Dupuytren's contracture of the hand is higher among alcoholics and patients with chronic diseases (eg, cirrhosis, diabetes, epilepsy, tuberculosis). Onset can be acute, but most often it is slow and protracted.

So far doctors do not know exactly what causes Dupuytren's contracture. There is no evidence that hand injuries or occupational accidents are related to hand vibrations that cause this condition.
If you are between the ages of 40 and 60, you may have a higher risk of Dupuytren's contracture than other age groups. This condition is more common in men.
Some factors that increase the risk of the disease include:
- Age : Dupuytren's contracture occurs most commonly after age 50. Symptoms increase with age.
- Gender: Men are more likely to have the disease and have more severe contractions than women.
- Race: People of Northern European descent, white people have a higher risk of developing the disease.
- Family history of the disease: According to research, people who have a father, mother, sibling or relative with the disease have a higher risk than others.
- Tobacco, alcohol: Smoking increases the risk of palmar spasm, probably due to microscopic changes in blood vessels caused by smoking. Alcohol abuse is also an implicated factor in the disease.
- Diabetes : People with diabetes are reported to be associated with this spasm.
- Seizures or use of antiepileptic drugs
- Body Mass Index (BMI): People with a BMI lower than normal are reported to be related to the disease.
Hand-related occupations such as craftsmen or hand injuries may be at risk for Dupuytren's contracture.

Nodules or lumps appear on the palm of the hand. Nodules are round or oval, flattened, firm, non-motile, 0.5 cm to 1.5 cm in diameter, with indistinct margins, painless to palpation. In rare cases, however, the nodules become red, painful, and itchy.
The skin is wrinkled or wrinkled like a dimple on the palm, fingers
Raised fibrous cords extend from the palm to the fingers. The fibrous cord is a few mm to 1 cm wide, and feels like a wire running under the skin. Normally it feels soft, but when stretched, the fingers become firm. Unlike the nodules, the fibrous cord has a well-defined margin and is mobile on palpation. Usually the fibrous cord and the nodules lie in a straight line in the direction of the fingers.
Flex your fingers to the palm of your hand. This is the late stage of the disease. The most affected fingers are the little and ring fingers. The middle finger can also be affected, very rarely involving the thumb and index finger. In which, the joints that are contracted are the metatarsal joints and the interphalangeal joints near the fingers.

Dupuytren's contracture is diagnosed primarily on the basis of a physician's physical examination. Supportive tests are rarely needed. The characteristic clinical signs of the disease are enough for the doctor to make a diagnosis:
- Trigger finger: unlike Dupuytren's contracture, trigger finger often hurts when flexing the fingers and is unable to extend the affected fingers. affect/

- Tendon bursitis : usually presents with pain and is caused by overactivity or trauma to the fingers.
- Lymphoid cyst : a small, easily palpable lump in the knuckles of the thumb may be a lymph node
- Soft tissue tumor: soft tissue tumor should be considered if the patient is young and has no other factors risk.

As the disease progresses, the doctor may recommend surgery. Surgical treatment involves breaking the ligaments in your finger. The doctor will choose some of the following treatment methods based on the severity of the disease:
- Acupuncture : using acupuncture therapy to break the contracture of the external ligaments. You may have spasms again, but you can still use acupuncture over and over again. The advantage of this therapy is that it can be done many times and helps your hand recover very quickly, however acupuncture cannot be used on every spasm because the needle can damage nearby nerves;
- Collagen injection: This is a minimally invasive procedure performed in a medical facility. Collagenase is injected into the fibrous band. The fibrous band is then broken through passive extension of the finger. The finger passive extension procedure was performed at 24, 48 or 72 hours after injection. The most common complications include injection site reactions, edema, bruising, bleeding, and pain. More serious reactions include tendon rupture and regional pain syndrome. These complications tend to be self-limited and resolve quickly, leaving no sequelae. Collagenase injections have been shown to reduce spasms by 75%, with a 35% recurrence rate.
- Corticosteroid injection: may improve the size of the nodule in some Dupuytren patients. Injecting at an early stage of the nodule without joint contracture can prevent disease progression. However, they are not effective in all patients and recur in up to 50%. Corticosteroid injections can lead to fat atrophy, change in skin color, and potentially rupture of tendons.

- Surgery: helps to remove muscle tissue, but this therapy needs to be done at a later stage after identifying the pulp tissue. Sometimes, this method has some difficulty if the muscle is removed without removing the skin attached. The disadvantage of surgery is the long recovery time and requires the use of physical therapy to mobilize the hand enough. and function properly. In rare cases, skin tissue may also be removed during surgery and necessitates a skin graft in the surgical area.

You should be able to control this disease if you take the following measures:
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