A 45 y.o. male comes in with a hand problem. He is unable to straighten his fingers.
what is this condition?
Our patient had Dupuytren’s contractures of both hands. This is caused by thickening of the palmar fascia which pulls one or more fingers into flexion. It is otherwise known as Viking’s hand since it is genetically transmitted and found most often in those of Northern European descent. The incidence is highest in Iceland. It was first described by Dupuytren and published in the Lancet after a successful operation was performed in 1831.
Palmar fascia gives the bowl shape to the palm at rest. It lies above the tendons.
The disease is painless and often presents with a small nodule in line with the ring finger.
Early Dupuytren’s
This can progress to a deformity of the hand which occurs mainly in men ages 40 to 59. There is variable penetrance of this autosomal dominant gene and in some individuals it progresses beyond the nodular stage to extensive fibrosis. These are patients with early onset of disease, bilaterality, and strong family history.
The fibrosis can affect other areas of the body. In a case report, a 12 y.o. boy with a mass on the foot was thought to have a fibrosarcoma on biopsy. The surgeon realized he had a strong family history of Dupuytren’s and the boy was followed for many years with no surgery and no progression. Pathology of Dupuytren’s can be confusing because it is a dysplasia of fibrous tissue.
While Dupuytren’s is associated with other diseases or injuries; no other condition other than genetic is currently suspected as a cause.
TREATMENT
No treatment is suggested in the early phase other than exercise; pressing the palm flat. If contractures occur such that the hand will not fit into your pocket (usually when 20 degrees of flexion occurs), )treatment is contemplated. Treatment depends on where the flexion occurs. If it is at the MCP joint a needle fasciotomy can be performed. Collagenase can also be injected which takes about 48 hours to dissolve the band, A splint is worn post injection. If both the MCP and finger joints are affected, surgery is thought to be the best option. In those cases a palmar fasciectomy is performed.
fascietomy involves multiple incisions across the fibrotic band.
FUN FACTS
Dupuytren was not only a hand surgeon, but also performed the drainage of the first brain abscess with trepanation. In addition to being a brilliant surgeon, unfortunately, as can occur with surgeons from time to time, he was reported as having a narcissistic and malignant personality which engendered deep animosity among his colleagues.
The Viking age of exploration began in 865 when England was conquered. Nordic genes spread Dupuytren’s throughout Europe
The Vikings raided widely . Their conquests gave us the word “Slavic” meaning “slave”.
Flatt A. The Vikings and Baron Dupuytren’s disease. 2001 Pro(Bayl Med Cent) 2001 Oct;14(4):378-384.
Hueston JT, Tubiana R, eds. Dupuytren’s Disease. London: Churchill Livingstone, 1985:123.
Fisk G. The relationship of manual labor and specific injury to Dupuytren's disease. In: Hueston JT, Tubiana R, editors. Dupuytren's Disease. London: Churchill Livingstone; 1985. pp. 104–105.
Bunting S. MSK pysiotherapist