What is Dupuytren’s?
Dupuytren's contracture, also called Viking disease, is a thickening and contracture of tissue beneath the skin on the palm and fingers. Dupuytren's disease is not restricted to the underlying tissue of the hand (called palmar fascia), but may also involve the skin and other surrounding tissue.
Dupuytren's contracture results from the growth of collagen fibres around the tendons in the palm. As collagen accumulates and the disease progresses, more of the palmar fascia becomes thicker and shortened. A cord-like band becomes apparent beneath the skin and the fingers begin to curl toward the palm. Eventually, it may be impossible for a patient to straighten their fingers or flatten their hand.
The condition was named after 19th century surgeon Baron Guillaume Dupuytren (1777–1835). He was the first to describe the contracture in detail during a December 1831 lecture.
Causes of Dupuytren’s
The cause of Dupuytren’s contracture is unknown; however, a family history makes it more likely one could develop the disease. In a study of patients with Dupuytren's contracture, 68% of the patients’ relatives had a history of the condition. It is unclear whether Dupuytren’s contracture is caused by one or multiple genes.
Dupuytren’s contracture is more common after the age of 40 and is uncommon in young people. Men can be up to fifteen times more likely than women to develop the condition. Dupuytren’s contracture typically occurs at a younger age in men than in women.
Suspected risk factors for Dupuytren’s contracture include smoking and excessive alcohol intake, and it is more common in people with diabetes and epilepsy. It is unclear whether Dupuytren’s contracture is caused by any particular occupations, lines of work or past trauma to the hand, although, a history of manual labour may indicate a worse prognosis.
Signs and Symptoms
Dupuytren's contracture can cause the fingers to curl toward the palm and reduce their function, especially the small (pinky) and ring fingers. Contracture can occur in one or both hands.
The initial signs of Dupuytren’s contracture may be a small nodule or lump in the palm of the hand. Over time, a patient may notice a cord-like band extending to the finger(s). The contracture sets in slowly and gradually it becomes more difficult to straighten the fingers. Eventually, finger joints may become fixed and rigid.
The severity and impact of Dupuytren's disease is different for every person, but it tends to be more aggressive when it develops in younger people.
Stages of Dupuytren’s
A useful test to help determine the advancement of Dupuytren's contracture is Hueston's Table Top Test. In this test, the patient places their hand, palm down, on a table. The disease is in an active state if the hand cannot be flattened on the table.
Dupuytren’s contracture can be classified into three stages: