Increasing the thickness and sum of the severity of the palmar fascia causes the fingers to bend with the fingers. The affected finger bends towards the palm of the hand. Remains in this state. This disease is called ‘Dupuytren contracture’
What is palmar fascia?
Under the skin of the palm is a solid membrane called the palmar fascia, which resembles a triangle whose base is adjacent to the base of the fingers. The tendons that bend our fingers toward the palm of the hand are adjacent to the plantar fascia or palmar fascia.
How is a duplex contract created?
The cause of the doublet contraction is unknown. In some people, for no apparent reason, part of this membrane or fascia thickens. As the thickness increases, the area of the curtain decreases and becomes so-called shorter. When the curtain is shortened, one or more fingers bend towards the palm of the hand and remain bent.
In non-diabetics, the most common fingers involved are the four and five fingers.And men are more likely to be infected than women.
In people with diabetes, fingers three and four are more involved, and diabetic women are more likely to develop Dupuytren contraction than diabetic men.
What are the risk factors for Dupuytren contracture?
Having the following characteristics makes a person prone to this conflict:
- Genetic factors
- Have a history of wrist fractures
- Being masculine
- Long-term diabetes
Jobs and activities that involve repeated pressure on the palm of the hand.
In this disease, the deposition of collagen (a protein that is present in the environment outside the cells of different species of different organisms) of type one and three increases the thickness of the palmar fascia.
What are the symptoms of Dupuytren contracture?
Dupuytren’s contraction is usually gradual, progressing painlessly for a long time.
Over time, thick bands form on the palm, the skin tightens, and thick, lumpy knots form on the palm.
Gradually, the range of motion of the finger is limited and the efficiency of the hand decreases.
There may be pain in some stages, but in advanced stages, the hand is not painful
Bruising of the fingertips can occur.
What is the diagnosis of duplex contracture?
- Chief complain
- Clinical examination
- Thyroid function test
Blood glucose and hemoglobin A1C tests (A1C hemoglobin test is a very common blood test that is effective in screening diabetics and shows how well patients have been successful in controlling diabetes.)
Note: If a progressive palm mass is seen in a young non-diabetic, it is best to have a biopsy to rule out sarcoma (any group of malignant tumors that target mesoderm-based cells or connective tissue). .
In some men, the skin on the soles of the feet or the penis undergoes similar changes.
Treatment of duplex contracture
- Non-surgical treatment
- Surgical treatment
Topical corticosteroid injection:
In cases where the severity of the disease is low, pain can be reduced by injecting steroids into the masses. These injections can also prevent the disease from progressing.
Oral anti-inflammatory drugs
Some people respond partially to the following treatments:
- Prolotherapy (topical and outpatient injections)
- Like PRP (plasma containing concentrated platelets)
- Ultrasound therapy
In advanced cases of duplex contraction where the function of the hand has decreased, the physician recommends surgery.
It is said that if the patient could not put his palm on a flat surface, surgery would be needed.
The surgeon removes part of the thickened tissue.
Post-surgery care for Dupuytren
The person will have swollen hands after surgery and should:
Hold your hand up
Start your limited movements gradually
Finger movements and strengthening the muscles of the hands and fingers are very important.
Perform physiotherapy sessions if necessary
The patient usually uses a splint six weeks after surgery. Sometimes it is recommended that the patient close the splint at night for another six months.
In cases where the disease recurs, limited surgery is sometimes necessary.
Complications of surgery include dry hands and fingers.