What is Dupuytren’s Contracture?
Dupuytren’s contracture is a disorder of the palmar fascia, a specific layer of connective tissue located just beneath the skin of the palm. The condition begins with a pathological thickening of this fascia, which first manifests as firm lumps or nodules developing in the palm. These initial nodules are typically not painful but are anchored to the skin.
Over time, these nodules can consolidate and extend to form tough, rope-like bands known as cords. It is the slow, progressive shortening and tightening of these cords that exerts a pulling force on the fingers, drawing them down into a permanently bent or flexed position. The ring and little fingers are the most frequently involved digits in this process, and the inability to straighten them is the hallmark of the contracture itself.
Causes:- Myofibroblast Proliferation: The condition is initiated by the excessive growth of cells known as myofibroblasts within the palmar fascia. For unknown reasons, these cells begin to multiply uncontrollably.
- Excessive Collagen Deposition: These proliferating myofibroblasts produce large amounts of a specific type of collagen. This excess collagen accumulates and organizes into the characteristic hard nodules and tough, fibrous cords that define the disease.
- Progressive Cord Contraction: Over a span of months or years, these collagen-rich cords gradually mature, shorten, and tighten. This slow but relentless contraction exerts a pulling force on the finger, tethering it to the palm and preventing it from being straightened.
- Genetic Lineage: The condition shows a powerful hereditary pattern, with a remarkably high prevalence among individuals of Northern European ancestry (Scandinavian, English, Scottish, Irish), earning it the nickname "Viking disease."
- Male Gender: Men are diagnosed with the condition far more frequently than women and also tend to experience an earlier onset and more severe contractures over time.
- Maturing Age: The incidence of the disease rises sharply after the age of 50, with the onset being extremely rare in people under the age of 40.
- Associated Conditions and Habits: The presence of diabetes, along with a history of long-term tobacco use or significant alcohol consumption, has been strongly correlated with a higher probability of developing the disease.
