Dupuytren's disease and osteopathy
What is Dupuytren's disease?
Dupuytren's disease, described in the 1830s, corresponds to an abnormal fibrous thickening (fibrosis) associated with a retraction of the palmar aponeurosis, i.e. the membrane located under the skin at the level of the palm of the hand.
This will cause nodules or fibrous flanges that will be found in the axis of the fingers. As it thickens, it will cause a retraction of the tissues and one or more fingers (depending on the extent of the damage) will progressively bend. The extension of the fingers and therefore the opening of the hand can be very limited or even impossible. The activities of daily life can therefore be very affected.
Who is affected by Dupuytren's disease?
In the United States, about 5% of the population is affected!
It affects men more frequently than women, especially around the age of 45.
There is a genetic cause but the presence of this gene does not necessarily mean that the person will develop the disease.
The risk factors are:
- Diabetes
- Alcoholism
- Epilepsy
Dupuytren symptoms:
- Presence of nodules or fibrous cords in the palm of the hand that follow the axis of the fingers. This is called a claw finger;
- Fingers more or less in flexion with limitation or impossibility to extend the finger;
- Impossible to put the hand flat on a table;
- Both hands are affected in 50% of cases (the right hand twice as often as the left).
Diagnosis of Dupuytren's disease
The diagnosis is primarily clinical and quite simple.
It lands on :
- Observation: deformations (nodules, cords) are visible
- Palpation: these deformities are palpable
- The test: it is possible to take one or more fingers in extension and observe the increase in deformities and the limitation of amplitude.
Imaging tests can confirm the diagnosis such as ultrasound, MRI, etc. but are not necessary.
Treatment of Dupuytren's disease
When to treat?
This disease does not disappear on its own, in the best of cases, it stagnates and the deformity and its repercussions do not evolve.
We recommend treating the disease as soon as functional discomfort appears on one or more fingers, i.e. when one or more fingers remain in slight flexion and this flexion is not reducible.
For example, the patient may be asked to place their hand completely flat on a surface and if they are unable to do so, treatment may be considered.
The different treatments :
Treatment depends on the stage and may range from injection of corticosteroids or collagenase into a nodule to surgical intervention. Percutaneous aponeurotomy with a needle is to be preferred before a more serious surgical intervention, if the stage allows it. It consists in cutting and dissecting the cords and fibrous nodules with mini needles.
Dupuytren's disease may recur after surgery if the removal of the membrane is incomplete or if new damage develops.
It is necessary to consult a hand surgeon.
Osteopathy and Dupuytren's disease
As much as we would like to, osteopathy does not cure Dupuytren's disease. It just allows to soften the tissues and to slow down the progression and to treat the compensations put in place by the body. It is therefore complementary to other approaches.
Marie Messager
Osteopath D.O
In Versailles
