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Dupuytren's contracture

Dupuytren's contracture (also called Dupuytren's disease, Morbus Dupuytren, Viking disease, palmar fibromatosis and Celtic hand) is a condition in which one or more fingers become permanently bent in a flexed position.[2] It is named after Guillaume Dupuytren, who first described the underlying mechanism of action, followed by the first successful operation in 1831 and publication of the results in The Lancet in 1834.[6] It usually begins as small, hard nodules just under the skin of the palm,[2] then worsens over time until the fingers can no longer be fully straightened. While typically not painful, some aching or itching, or pain,[7] may be present.[2] The ring finger followed by the little and middle fingers are most commonly affected.[2] It can affect one or both hands.[8] The condition can interfere with activities such as preparing food, writing, putting the hand in a tight pocket, putting on gloves, or shaking hands.[2]

Not to be confused with Dupuytren fracture.

Dupuytren's contracture

Dupuytren's disease, Morbus Dupuytren, palmar fibromatosis, Viking disease, and Celtic hand,[1] contraction of palmar fascia, palmar fascial fibromatosis, palmar fibromas[2]

Rheumatology

One or more fingers permanently bent in a flexed position, hard nodule just under the skin of the palm[2]

Trouble preparing food or writing[2]

Gradual onset in males over 50[2]

Unknown[4]

Family history, alcoholism, smoking, thyroid problems, liver disease, diabetes, epilepsy[2][4]

Based on symptoms[4]

Steroid injections, clostridial collagenase injections, surgery[4][5]

~5% (US)[2]

The cause is unknown but might have a genetic component.[4] Risk factors include family history, alcoholism, smoking, thyroid problems, liver disease, diabetes, previous hand trauma, and epilepsy.[2][4] The underlying mechanism involves the formation of abnormal connective tissue within the palmar fascia.[2] Diagnosis is usually based on a physical exam.[4] Blood tests or imaging studies are not usually necessary.[8]


Initial treatment is typically with cortisone injected into the affected area, occupational therapy, and physical therapy.[4] Among those who worsen, clostridial collagenase injections or surgery may be tried.[4][5] Radiation therapy may be used to treat this condition.[9] The Royal College of Radiologists (RCR) Faculty of Clinical Oncology concluded that radiotherapy is effective in early stage disease which has progressed within the last 6 to 12 months. The condition may recur at some time after treatment;[4] it can then be treated again. It is easier to treat when the amount of finger bending is more mild.[8]


It was once believed that Dupuytren's most often occurs in white males over the age of 50[2] and is rare among Asians and Africans.[6] It sometimes was called "Viking disease," since it was often recorded among those of Nordic descent.[6] In Norway, about 30% of men over 60 years old have the condition, while in the United States about 5% of people are affected at some point in time.[2] In the United Kingdom, about 20% of people over 65 have some form of the disease.[6]


More recent and wider studies show the highest prevalence in Africa (17 percent), Asia (15 percent).[10]

or Northern European ancestry;[20] Dupuytren's has been called the "Viking disease",[6] though it is also widespread in some Mediterranean countries, e.g., Spain[21] and Bosnia.[22][23] Dupuytren's is uncommon among groups including Chinese and Africans.[24]

Scandinavian

In June 2023 a study found that gene variants that were inherited from Neanderthals dramatically increased the odds of developing the condition

[25]

Male sex; men are 80% more likely to develop the condition[20][26]

[13]

Age of 50 or over (5% to 15% of men in that group in the US); the likelihood of getting Dupuytren's disease increases with age[24][26]

[13]

A (60% to 70% of those affected have a genetic predisposition to Dupuytren's contracture)[13][27]

family history

Diagnosis[edit]

Types[edit]

There may be three types of Dupuytren's disease:[31]

The skin is clinically involved (pits, tethering, deficiency, etc.)

The risk of recurrence is high and the skin appears uninvolved (subclinical skin involvement occurs in ~50% of cases)

[50]

Recurrent disease. Similar to a limited fasciectomy, the dermofasciectomy removes diseased cords, fascia, and the overlying skin.[51]

[41]

Prognosis[edit]

Dupuytren's disease has a high recurrence rate, especially when a person has so-called Dupuytren's diathesis. The term diathesis relates to certain features of Dupuytren's disease, and indicates an aggressive course of disease.[32]


The presence of all new Dupuytren's diathesis factors increases the risk of recurrent Dupuytren's disease by 71%, compared with a baseline risk of 23% in people lacking the factors.[32] In another study the prognostic value of diathesis was evaluated. It was concluded that presence of diathesis can predict recurrence and extension.[80] A scoring system was made to evaluate the risk of recurrence and extension, based on the following values: bilateral hand involvement, little-finger surgery, early onset of disease, plantar fibrosis, knuckle pads, and radial side involvement.[80]


Minimally invasive therapies may precede higher recurrence rates. Recurrence lacks a consensus definition. Furthermore, different standards and measurements follow from the various definitions.