Going Straight

Senior Times

Bill O’Brien on a condition to the hand which is more common than you might think.

It started with a callous in the middle of my palm. Then over a period of probably months the callous became more of a long lump. I reckoned I had damaged a tendon and thought no more about it. Since there was noi pain I gave it no more thought. At this stage my little finger was probably beginning to incline inwards but I did not notice.

It was not until about a year or more that I noticed that not only my little finger, but also my ring finger were beginning to incline inwards. This was of course when I should have gone to my doctor, but like most men I chose to ignore it, and there was no pain. Eventually - probably after about three years -- I could ignore it no longer as it was beginning to become a problem; for example I could not get a glove on to this hand.

Dupuytren’s Contracture

Eventually I went to my doctor who diagnosed Dupuytren’s Contracture. With this deformity, the fingers affected can still bend in toward the palm as normal but cannot fully straighten. The ring and little fingers are most commonly affected as the thumb and index finger are practically never given trouble. The abnormality occurs when connective tissue beneath the skin of the palm scars after it has thickened and shortened.

When the contracture is taking place it will usually happen over time and is painless but leaves the person with an increasingly hard time using the hand as normal. There is no pain involved although the bumps that can form on the palm and be tender. Most often the condition doesn’t begin until the age of 40 but the number of people affected will grow in later years. In the numbers affected just after the age of 40, the number of men is more than women but around the age of 80, the frequency in both genders is about even.

Dupuytren’s Contracture has been found to be be associated with Viking descent. The condition has a strong affiliation with genetics and so will often be hereditary. Also manual labor that involves a lot of work with the hands can be associated with the condition. Dupuytren’s will sometimes occur along with syndromes like Peyronie’s disease, Ledderhose’s disease and Riedel’s struma.

On the other hand, smoking, drinking, diabetes, epilepsy, and liver disease have all been considered risk factors for Dupuytren’s. In the case of alcoholism, it hasn’t been proven whether it is the excessive drinking that can lead to the contracture or if it is the effect it has on the liver. As it pertains to epilepsy, it is not for certain whether the condition itself or the medication needed for someone with epilepsy is the real cause for the contracture. The form of disfigurement on the hand for someone with diabetes is a bit different than that of the usual condition. Sensitive lumps will form on the palms but will not always result in contracted fingers.

The condition is named after a French surgeon called Baron Guillaume Dupuytren. Dupuytren is responsible for creating the procedure that can correct the problem. Today, several procedures now exist to help provide relief. These all have more of an effect depending on what stage of the contracture they are used at. In most cases, there is no way to completely ensure Dupuytren’s will not come back. There is no cure, just different options that can slow the process or alleviate any pain that may occur.

If the person has a severe case of the contracture, as it has progressed to be too painful or has caused disability, then surgery is most often the best choice. For those who cannot or do not want to undergo extensive surgery, a procedure which releases cords of tissue is conducted. This mainly involves the surgeon making a small incision in order to cut the tissue. This can fix the fixed flexion but there is no guarantee that it will not recur afterward.

The most common procedure has been partial tissue removal. During this operation, as much of the diseased tissue is removed as possible. Unfortunately, it can be hard to identify the diseased tissue from the healthy tissue and so after this procedure it is common for the contracture to recur but in most cases it is not nearly as severe as before. Complete tissue removal is suitable for anyone who has a high risk of Dupuytren’s recurring after any of the other procedures. The tissue underneath the palm is completely removed and leaves very little chance of recurrence but may also have the worst complications of any of the other options.

There are options that can be considered before surgery. Radiotherapy, using low energy x-rays, can prevent the condition from occurring if it is caught in its earlier stages. If the therapy is done over time after early detection, the contracture can be avoided. In needle aponevrotomy small needles are used in a minimal invasive procedure that weakens the affected tissue. After this, if the fingers are pulled straight the weakened tissue may snap and then heal, returning healthy tissue. Currently in stages of approval is another procedure similar to needle aponevrotomy. Instead this therapy involves the injection of collagenase which is used to weaken the tissue.

Samuel Beckett and Margaret Thatcher are two well-known names that have been affected by the condition in the past.. Dupuytren’s most frequently occurs after the age of 40 but if recongnised at an early stage, a more severe case can be avoided.

It is six months since my surgery, and while my hand is still a bit tender and weak, my fingers are all almost straight. (Apparently the fingers never return 100 per cent, and sometimes the condition can return which I can’t wait for).

Whatever, don’t leave it as long as I did. Look for that callous or lump in the middle of your palm.

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