Dupuytren's contracture

Dupuytren's contracture (also called Dupuytren's disease, Morbus Dupuytren, Palmar fibromatosis and historically as Viking disease or Celtic hand) is a condition in which one or more fingers become permanently bent in a flexed position. It is named after Guillaume Dupuytren, who first described the underlying mechanism of action, followed by the first successful operation in 1831 and publication of the results in The Lancet in 1834. It usually begins as small, hard nodules just under the skin of the palm, then worsens over time until the fingers can no longer be fully straightened. While typically not painful, some aching or itching, or pain, may be present. The ring finger followed by the little and middle fingers are most commonly affected. It can affect one or both hands. The condition can interfere with activities such as preparing food, writing, putting the hand in a tight pocket, putting on gloves, or shaking hands. The cause is unknown but might have a genetic component. Risk factors include family history, alcoholism, smoking, thyroid problems, liver disease, diabetes, previous hand trauma, and epilepsy. The underlying mechanism involves the formation of abnormal connective tissue within the palmar fascia. Diagnosis is usually based on physical examination. In some cases imaging may be indicated. In 2020, the World Health Organization reclassified Dupuytren's (termed palmar-type fibromatosis) as a specific type of tumor in the category of intermediate (locally aggressive) fibroblastic and myofibroblastic tumors. Initial treatment is typically with cortisone injected into the affected area, occupational therapy, and physical therapy. Among those who worsen, clostridial collagenase injections or surgery may be tried. Radiation therapy may be used to treat this condition. The Royal College of Radiologists (RCR) Faculty of Clinical Oncology concluded that radiotherapy is effective in early stage disease which has progressed within the last 6 to 12 months. The condition may recur at some time after treatment; it can then be treated again. It is easier to treat when the amount of finger bending is more mild. It was once believed that Dupuytren's most often occurred in white males over the age of 50 and was thought to be rare among Asians and Africans. It sometimes was called "Viking disease," since it was often recorded among those of Nordic descent. In Norway, about 30% of men over 60 years old have the condition, while in the United States about 5% of people are affected at some point in time. In the United Kingdom, about 20% of people over 65 have some form of the disease. More recent and wider studies show the highest prevalence in Africa (17 percent), Asia (15 percent).