Dupuytren’sche Contracture (DC)
Dupuytren’s contracture (DC) is, in contrast to the widely held view, not “tendon shortening”. It is a benign proliferation of a specific connective tissue under the skin of the palm of the hand: the “palmar aponeurosis”. It mainly concerns the change in the collagen of the palmar aponeurosis, in which there is a transformation of the normal collagen with the same increased expression of another collagen type, which is shrinking. This shrinks the overlying skin, and the fingers will sometimes remain in flexion.
Dupuytren’s contracture is not dangerous, probably hereditary and can result in untreated cases in severe deformities of the hand and fingers. There is no drug therapy for DC, the best cure is achieved by surgical removal of the altered palmar aponeurosis.
The operation is actually very challenging, because important nerves and vessels must be protected during the removal of the palmar aponeurosis. If the fingers are also affected, Z-plasties or in especially serious cases, skin grafts need to be brought in.
For the successful treatment of DC an intensive physical therapy is needed to mobilize finger joints as early as possible and to treat immediately an unpleasant complication “reflex sympathetic dystrophy” (a not entirely clear, infrequent severe reaction to surgery of the hand resulting in pain, swelling, burning, etc.).
The health insurance companies cover the cost of the operation.