DUPUYTREN’S CONTRACTURE

**DUPUYTREN’S CONTRACTURE **

Definition

• Dupuytren's contracture is a chronic, progressive, fibroproliferative disorder of the palmar aponeurosis, characterized by the formation of nodules and cords of fibrous tissue, leading to flexion deformity of the fingers.

Types

• Primary Dupuytren's contracture: most common type, occurring in individuals without a known history of trauma or other predisposing factors.
• Secondary Dupuytren's contracture: occurs in individuals with a known history of trauma or other predisposing factors, such as diabetes, alcoholism, or liver disease.
• Dupuytren's disease: a term used to describe the early stages of the disease, before the formation of nodules and cords.
• Dupuytren's contracture: a term used to describe the later stages of the disease, characterized by the formation of nodules and cords.

Causes

• The exact cause of Dupuytren's contracture is unknown, but it is thought to be related to a combination of genetic and environmental factors.
• Trauma to the hand or palm may trigger the development of Dupuytren's contracture in some individuals.
• Certain medical conditions, such as diabetes, liver disease, or alcoholism, may increase the risk of developing Dupuytren's contracture.
• Hormonal changes, such as those that occur during pregnancy or menopause, may also contribute to the development of Dupuytren's contracture.

Clinical Features

• Nodules and cords of fibrous tissue form in the palmar aponeurosis, leading to flexion deformity of the fingers.
• The most commonly affected fingers are the ring and little fingers.
• The deformity typically begins with a flexion contracture of the ring finger, followed by the little finger.
• The disease may progress to involve multiple fingers and the palm.
• Pain is not typically a symptom of Dupuytren's contracture, but the deformity may cause discomfort or difficulty with hand function.

Investigations

• Physical examination: diagnosis is typically made based on physical examination, with the use of a palpable mass in the palmar aponeurosis.
• Imaging studies: such as X-rays or ultrasound, may be used to rule out other conditions that may cause similar symptoms.

Complications

• Flexion deformity of the fingers may lead to difficulty with hand function and daily activities.
• The deformity may also cause discomfort or pain.
• In rare cases, Dupuytren's contracture may progress to cause flexion contracture of the thumb or other digits.
• The disease may also cause nodules and cords to form in other parts of the body, such as the plantar fascia or the penis.

Management

• Observation: in the early stages of the disease, observation may be the most appropriate course of action.
• Physical therapy: may be used to improve hand function and reduce the severity of the deformity.
• Corticosteroid injections: may be used to reduce inflammation and relieve symptoms.
• Surgery: may be necessary to correct the deformity, especially in cases where the disease has progressed significantly.

Surgical Steps → Step 1: The patient is positioned in a supine position, with the affected hand placed on an armboard. → Step 2: The skin is prepared and draped, and the affected area is exposed. → Step 3: An incision is made in the palmar aponeurosis, and the nodules and cords are identified. → Step 4: The nodules and cords are excised, and the palmar aponeurosis is released. → Step 5: The skin is closed, and the patient is monitored for complications.

Homoeopathic Therapeutic Medicines

• Arnica: used to reduce inflammation and relieve pain.
• Ruta: used to relieve pain and stiffness in the fingers.
• Silica: used to relieve pain and stiffness in the fingers.
• Symphytum: used to promote healing and reduce inflammation.

Blood Supply

• The blood supply to the palmar aponeurosis is provided by the palmar arches and the radial and ulnar arteries.

Nerve Supply

• The nerve supply to the palmar aponeurosis is provided by the ulnar and median nerves.

Clinical Anatomy

• The palmar aponeurosis is a thickened band of fibrous tissue that lies deep to the palmar fascia.
• The nodules and cords of Dupuytren's contracture form in the palmar aponeurosis.