Dupuytren Contracture (cont.)

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Is a Dupuytren's contracture limited to the hands?

Interestingly, a Dupuytren's contracture is sometimes associated with inflammation and thickening of the fascia tissue in a similar manner of the sole of the foot. This condition is called Ledderhose disease, or plantar fascial fibromatosis, and is sometimes associated with plantar fasciitis. It can sometimes be felt as a nodule or group of nodules in the middle of the sole of the foot.

Very rarely, a Dupuytren's contracture occurs in association with an uncommon scarring condition of the penis called Peyronie's disease.

How is a Dupuytren's contracture diagnosed?

A Dupuytren's contracture is diagnosed by the doctor during the physical examination of the affected hand. X-rays and other tests are usually not necessary.

Previous burns or hand injury can lead to scar formation in the palm of the hand that can mimic true a Dupuytren's contracture.

What is the treatment for a Dupuytren's contracture?

The treatment of a Dupuytren's contracture depends on the severity and the underlying condition of the affected individual.

Most patients with a Dupuytren's contracture require reassurance and stretching exercises with heat application. When the palm is persistently sore with grasping, ultrasound treatments can be helpful. Sometimes local inflammation is best relieved with cortisone injection.

For patients with significant fixed flexed posture (contracture) of the fingers from a Dupuytren's contracture, when nonsurgical treatments have failed, surgical procedures can remove the scarred tissue to free the fingers and release the tendons. These procedures can return function to a disabled hand. Minor nodule formation and/or skin thickening of the palm is not a reason to operate. Sometimes the surgeon can release the scarred tissue by carefully cutting it with a needle. This procedure is referred to as a needle aponeurotomy or needle fasciotomy.

A newer treatment for a Dupuytren's contracture is collagenase (Xiaflex) injection. The scar tissue that forms the contracture is composed of a protein network called collagen. Collagenase is an enzyme that breaks up the collagen, which can then loosen the contracted tissue to restore finger mobility. Collagenase is directly injected into the contracted "cord" of scar tissue that causes the Dupuytren's contracture.


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