Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dupuytren contracture is a
localized formation of scar tissue beneath the skin of the
palm of the hand. The scarring
accumulates in a tissue (fascia) that normally covers the tendons that pull the fingers to
grip. As Dupuytren contracture progresses, more of the
fascia becomes thickened and shortened. Dimpling and
puckering of the skin over the area eventually occurs.
How fast does Dupuytren contracture develop?
Dupuytren contracture
varies in its rate of progression from minor skin
puckering for many years to rapid contracture (fixed flexed
position) of
fingers.
Dupuytren's contracture can be inherited. In medical
terms, the inherited form of Dupuytren's contracture is transferred in the family
as a so-called autosomal dominant trait with incomplete penetrance and partial
sex-limitation. This means that the gene for Dupuytren contracture is not on an
X or Y chromosome (sex chromosome) but on one of the other 44
chromosomes. Consequently, one version of the gene is enough
to cause the disorder (it is dominant), but not everyone who
has the gene has the disorder (the gene is not fully penetrant) and the disorder is most frequent in males (the
gene expression is partially limited to males).
What are the symptoms of Dupuytren contracture?
Dupuytren contracture initially may cause only a minor
painless lump in the palm of the hand near the base of the finger(s). Dupuytren contracture most commonly affects
the ring (fourth) finger, but it can affect any and all
fingers. Dupuytren contracture can also affect one or
both hands.
As Dupuytren contracture progresses, it can lead to an
inability to fully extend the affected finger from the
flexed position. This can result in a loss of normal
grasping.
Dupuytren contracture is seldom associated with much, if
any, pain unless the affected fingers are inadvertently forcefully hyperextended.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
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