Dupuytren's contracture, French disease or palmar fibromatosis, called scar deformity and shortening of the tendons Brush the area, which lead to bending and fixing the fingers in an unnatural position, and they can not be completely unbend. Most often suffer the little finger and ring finger on one or both hands.
Causes
Dupuytren's contracture is characterized mainly for middle-aged men, the occurrence at a young age - a rarity, but it is quicker and leads to persistent and severe deformity of the brush. With increasing age the incidence of Dupuytren's contracture increases as the disease progresses slowly. More likely to suffer from it the inhabitants of Europe, Ireland and the Scandinavian countries.
Basically when Dupuytren's contracture is affected:
- palmar surface of a hand on one or both hands,
- describes the destruction of the sole,
- somewhat less affected by the interphalangeal joints of the hands,
- rarely affects the cavernous body of the penis.
At present, the exact cause of the disease is not clear, but with Dupuytren's contracture in families can be traced to genetic predisposition. Typically, a gene is transferred to the X-chromosome with incomplete dominance, and thus, manifests itself in men active.
It puts forward several theories of origin of Dupuytren's disease:
- wrist injury and individual fingers,
- neurogenic origin strain (pinching the nerves going to the hand and fingers),
- endocrine disorders,
- hereditary defect in the connective tissue,
- physical overload the brush,
- inflammation of the ligaments, but the past is invisible but to leave the consequences.
It is believed that Dupuytren's contracture is not limited to the brush, but the whole of the connective tissues of the body, with a "favorite" localization in hand.
Predisposing factors for the development of Dupuytren's disease are:
- smoking,
- alcoholism,
- diabetes,
- epilepsy.
Manifestations of Dupuytren's contracture
Normal brush able to fully bend and straighten all the fingers. If it affects the palmar Dupuytren's contracture bunch of each finger as it shrinks and does not completely straighten the finger possibilities. At the same time it is developing a traffic violation in the joints affected fingers, until their complete immobility. In this case formed ankylosis - fused joint surfaces. On the surface of the palm of the tendons in the projection units are formed. They can be painful.
Based on the fact, which was originally developed defeat distinguish palm, digital, mixed form kontrakrury Dupuytren.
Dupuytren's contracture is a disease-step, is divided into four stages of damage.
In the first step are shown:
- subcutaneous seal in the palm area,
- finger movements almost are not limited to,
- the changes do not interfere with normal life,
- There were no significant cosmetic defects.
The second stage is usually manifested:
- limiting the passive finger extension for not more than 30 degrees,
- slight limitation in hand function,
- no pain,
- there is a full and pronounced effect on operations.
In the third stage is formed:
- a defect in the toe leaves the extension from 30 to 90 degrees,
- finger permanently bent,
- there is pain in the wrist,
- markedly broken hand function,
- do not have full effect in the operation, extension of the defect can not be eliminated completely.
In the fourth step occurs:
- transition of pathological process on the tendons and joints,
- persistent changes in the fingers,
- fusion joint surfaces (contracture)
- shortage of extension of fingers more than 90 degrees, the finger hardly unbent,
- surgical treatment of little effect, but often have to carry out several complex operations.
- brush strongly deformed and can not perform its functions.
Diagnostics
The preliminary diagnosis is based on patient examination and questioning, clarifying the presence of such anomalies with relatives.
It determines the degree of deformation and the ability to manipulate the brush, an angle extension fingers and the presence of nodules in the area of the hand tendons. Basically, with the apparent additional clinical diagnostic methods are required.
Treatment of Dupuytren's contracture
The treatment takes orthopedic surgeon. There are two areas of treatment - conservative therapy and surgical methods.
The choice of method depends on the severity and duration of the disease, and how limited joint mobility and hand function.
The basis of the choice of treatment - degree of change tendons in the palm area, which probes the doctor, lesion size and condition of the surrounding tissues in the palm of your hand.
By conservative methods include:
- physiotherapy thermal procedures (paraffin wax, mineral wax).
- exercises for stretching the tendons,
- Longuet imposition of the maximum position unbent fingers during sleep,
- Ultrasonic treatment
- electrophoresis,
- corticosteroid injections.
- therapeutic blockade of local anesthetics with hormones.
Conservative therapy can only slow down the flow of Dupuytren's contracture. But do not stop it, sooner or later will require surgical correction.
To surgical methods include a needle aponeyrotomiyu (removal of nodules special needles).
Surgery is indicated when the finger flexion angle bounded already at 30 degrees. In this fully or partially excised tendinous fascia and pathological strands.
When pronounced changes spend arthrodesis - make finger straight, but with a fixed joint. In very severe cases, when the connective tissue is greatly expanded and was struck by nerves and blood vessels can be even amputation of a finger.
