About Dupuytren's Contracture
Dupuytren's contracture is a progressive conditions that eventually leads to a hand deformity. It affects connective tissue of the palm. In patients suffering from Dupuytren's contracture knots of connective tissue form under the skin, they create a thick cord which eventually leads to pulling of one or even more fingers into a bent position. The affected fingers remain in that position and a patients is not able to straighten them any more. In majority of cases Dupuytren's contracture affects the ring and the little finger.
Dupuytren's contracture progresses slowly over years and only in small number of patients the symptoms and signs may develop rapidly within weeks or months. Initial symptoms include puckered and dimpled appearance of the skin that covers the affected tissues. What follows is forming of a firm lump inside the palm. This lump may be tender to touch but is generally painless. Further progression of the condition features with forming of cords of connective tissue under the skin of the palm. These cords drag the affected fingers into the bent position.
Standard Treatments for Dupuytren's Contracture
Treatment is not indicated in case the condition does not cause any pain or has no impact on one's ability to use hands for everyday tasks. Only patients with progressive form of the disease as well as those who cannot perform regular daily activities due to contracture are treated.
Needling is a procedure in which the cord of tissue responsible for finger bending is 'broken'. The advantage of needling is an absence of incisions and the technique can be performed on several fingers at the same time. Enzyme injections (collagenase clostridium histoluticum) are administered into the affected area. They effectively soften and weaken the cord in the palm. The day after injecting the enzyme the doctor manipulates patient's hand in order to break the cord and bring the fingers in the normal position. And finally the surgery for Dupuytren's contracture provides with complete joint release. After the surgery patients undergo physical therapy.
Radiation Therapy for Dupuytren's Contracture
Radiation therapy is another treatment modality for Dupuytren's contracture. It can damage special type of cells (fibroblasts) that develop as a part of lumps in the palms. The efficacy of radiation therapy is still controversial because there is not sufficient data confirming all the positive effects and possible side effects of such treatment.
Positive side effects of radiation therapy include cessation of the growth of Dupuytren nodules or cords. They stop growing permanently or for a longer period of time. It is essential to mention that radiation therapy cannot straighten already bent fingers. The overall effects of such therapy depend on the stage of the disease.
Potential side effects of radiation therapy for Dupuytren's contracture are radiation injury to the skin and in case of higher doses or if treatment lasts for a longer period of time the risk of cancer increases.