Dupuytren is a disease of thickening andhardening of the skin and subcutaneous tissue of the palms. Also called Dupuytren's contracture, this condition causes the palm to pull inward,restricting hand movements and giving the joints an abnormal appearance.Dupuytren's syndrome, which is usually seen in middle-aged individuals, can betreated quite easily and quickly with early intervention.
What Causes Dupuytren?
Dupuytren's disease is a deformity that usuallytends to progress over years. The knotting that starts in the tissue layer ofthe palm creates a thick cord, causing the fingers to bend. Dupuytren's disease, whose exact cause is unknown, usually affects the fingers farthestfrom the thumb and is most common in men over the age of 40. In addition,factors such as alcohol and cigarette use, systemic disorders, diabetes,genetic factors and working in jobs where hands are used intensively increasethe risk of disease development.
What Are Dupuytren's Symptoms?
Dupuytren's disease, which starts with thethickening of the palm tissue, progresses over time and affects the fingers. Asa result, the fingers are pulled into a bent position and become unusable, andthe person may have difficulty during daily activities such as wearing gloves,washing hands, holding objects.
This problem, which is generally painless, cansometimes cause mild pain and can be understood as follows, although it doesnot cause any obvious symptoms:
- It has an insidious onset and may cause painless swelling in the palm and 4th and 5th fingers.
- The swellings on the hand increase in the form of bands over time, thicken and harden.
- In advanced cases, the fingers lose their flexibility and begin to withdraw.
- A dome-like protrusion forms on the palm and does not fully contact when held on a flat surface.
- Moving and closing the fingers becomes increasingly difficult.
Dupuytren has the risk of affecting adjacentvessels, nerves and tendons and will not regress or heal on its own. For thisreason, hand functions can be irreversibly lost in cases that are not treatedin a timely manner.
How Is Dupuytren's Treatment?
The severity and stage of the disease aredecisive in the treatment of Dupuytren. Since it generally progresses insidiously,the pulling in the tendons can increase rapidly and bring the disease to aserious level. After the general examination and patient complaints,ultrasonography is used to observe the thickening of the tissues and theformation of nodules. Surgical operation or other treatment methods can beevaluated together with the diagnosis.
- In the presence of nodules that do not cause limitation of movement in the fingers, surgical intervention is generally not recommended and cortisone treatment is applied by injection. In this way, the opening and closing problems in the fingers are resolved in about 2-3 weeks, but this method is not enough for advanced cases.
- Other methods that can be used in the early stages are physical therapy and exercise. The use of special splints that keep the fingers open and the application of exercises under the supervision of a physician can regain movement to the joints.
- Acupuncture needles also provide treatment at an early stage without the need for surgery and greatly alleviate the development of contractures.
These treatments, which are organized insessions, are applied with the recommendation of the physician and eliminatethe need for surgery. After acupuncture, massage and stretching applications,the person's complaints are resolved, but there is a risk of recurrence of thedisease. In such cases and advanced cases, surgical operation is required.
How Is Dupuytren's Surgery Done?
Treatment of advanced cases with contracturesis surgical and includes removal or lengthening of thickened tissues. As thesurgical intervention is delayed, the chance of regaining finger movementsdecreases, therefore, the appropriate operation should be performed in theearliest period. Before the operation, the damaged tissues are determined andit is decided which area to intervene.
The methods used during the operation, whichis usually performed under local anesthesia, vary according to the needs of theperson. Generally, the operation is completed by removing the thickened tissuesin the palm without damaging the nerves and vessels. In case of tendonadhesion, repair procedures are performed in these tissues. Sometimes, due tothe reduction or tearing of the skin surface during the tissue removal stage,this deficiency must be completed with skins taken from another part of thebody.
Post-Surgery Considerations
Since Dupuytren develops around the fingernerves, the operation must be performed with extreme caution. Since there is arisk in every operation, there is a risk of nerve damage and bleeding duringthis procedure, but these risks are minimized under the control of a specialistdoctor. After the successful operation, the person is usually discharged on thesame day and uses a splint for 2-3 weeks. After the splint and sutures areremoved, the person is directed to physical therapy and followed up regularly.In the meantime, it is necessary to perform movements and to use the medicinesprescribed by the physician, if any, without interruption.
The choice of physician is extremely importantin dupuytren surgery, which requires care and expertise. With the right choiceof physician, it is possible for the person to receive the most appropriatetreatment and regain finger functions.
Since Dupuytren develops around the fingernerves, the operation must be performed with extreme caution. Since there is arisk in every operation, there is a risk of nerve damage and bleeding duringthis procedure, but these risks are minimized under the control of a specialistdoctor. After the successful operation, the person is usually discharged on thesame day and uses a splint for 2-3 weeks. After the splint and sutures areremoved, the person is directed to physical therapy and followed up regularly.In the meantime, it is necessary to perform movements and to use the medicinesprescribed by the physician, if any, without interruption.
The choice of physician is extremely importantin dupuytren surgery, which requires care and expertise. With the right choiceof physician, it is possible for the person to receive the most appropriatetreatment and regain finger functions.
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