Dupuytren's contracture is a deformity of the hand that affects the tissue that sits just under the skin of the palm, causing knots to form in this area. The knots that form under the skin f the palm can develop a dense cord of which may draw one or more of the fingers into an arced bent position. This deformity causes an affected individual to be unable to straighten their fingers. Everyday tasks that involve the fingers in such a position become increasingly difficult. The two fingers located opposite from the thumb are the most commonly affected fingers. This deformity is diagnosed through a physical examination. Individuals with severe forms of Dupuytren's contracture may need to be treated with enzyme injections or surgery to sever the cord of tissue pulling on the fingers.
Age Of Patient
The age of a patient can cause them to be at an increased risk of developing Dupuytren's contracture. This deformity is an uncommon occurrence in individuals within their first four decades of life. The average age of Dupuytren's contracture diagnosis is sixty years old. Several mechanisms are known to play a role in this risk factor. This deformity is characterized by the growth of an abnormal thick cord of tissue in the hand over many years. Because it takes several years for the deformity to develop and manifest, older individuals are more likely to be affected. This abnormal cord grows as a result of the narrowing of microvessels in the localized area of the hand that causes hypoxic conditions. When these local tissues become hypoxic, the immune system goes to work to help mediate any damage from oxygen deprivation. Fibroblasts are stimulated, which result in an increase of free radicals. Free radicals cause more abnormal multiplication of cells. This cell growth eventually forms the cord that pulls on the patient's fingers. Older individuals are also at an increased risk of the deformity being triggered by an injury or recurrent trauma.
An individual's ancestry may place them at an increased risk of developing the Dupuytren's contracture deformity. Caucasian skinned individuals are the group most affected by this deformity. Between four and six percent of Caucasians are affected worldwide by Dupuytren's contracture. The risk becomes tripled if a Caucasian individual's ancestry is from any location across northern Europe. Individuals of Asian descent are affected by this deformity at a rate of three percent worldwide. A concentration of Dupuytren's contracture has been reported in a few other countries such as Zimbabwe, Tanzania, and East Africa. This deformity is a rare occurrence in individuals of Native American or Indian descent. It is also uncommon in individuals who have Hispanic ancestry. While a family history of the deformity is a different risk factor in itself, changes in the 16q gene have been reported in individuals who are a part of numerous generations of specific origins. The geographical relationship in these factors suggests this deformity occurred in ancestors who needed to have a strong hand.
Increased risk factors have been determined and strongly supported in certain genders at different ages. The occurrence of Dupuytren's contracture in men is three times greater then it is in women for most age groups. Around eighty percent of all individuals diagnosed with Dupuytren's contracture are men. Males are also more likely to develop the deformity at a younger age and experience it in a more severe form than women. It is estimated one of every ten men in their fifties are affected by Dupuytren's contracture. When the age increases to men in their seventies, it is estimated this deformity affects one in every four men. Only one in every ten women in their seventh decade of life are affected by Dupuytren's contracture. It is only when the age group exceeds eighty-five years old that the incidence of this deformity is slightly higher in women than it is in men. The exact mechanism of this incidence is not clear, but the androgen receptor expression in the Dupuytren fascia in men has been said to play a role in it.
One of the strongest increased risk factors for Dupuytren's contracture is a family history of the deformity. The ratio of the sibling reoccurrence risk of this deformity is 2.9. Dupuytren's contracture is characterized by a tough cord of tissue that develops in the hand abnormally. The tissues in this cord have shown to display an upregulation and increase of the MafB gene. The MafB gene, which can be inherited, plays a role in specific processes that pertain to cell differentiation and the development of tissues. It has also been proven a maternal genome that can be inherited causes dysfunctional mitochondria in certain cells. These mitochondria result in the high generation of free radicals in the localized region of specific tissues. This dysfunctional mitochondria also produce a defective process of cell death. These genetic abnormalities cause a proliferation of cells in the hand where the thick cord develops in Dupuytren's contracture. Genetic factors have also been identified that involve polymorphism in the region of mitochondrial DNA identified as 16s rRNA. Familial histories that include trisomy seven and trisomy eight have been shown to increase the risk of developing the deformity. Any inherited disorders that cause peripheral nerve damage can also increase an individual's risk.
Individuals affected by both types of diabetes are at an increased risk of forming Dupuytren's contracture. In fact, around one-fifth of all diabetes patients are affected by this deformity. Additionally, diabetes patients only make up five percent of all individuals diagnosed with Dupuytren's contracture. Both type one and type two diabetes increase an individual's risk for the deformity, but it affects patients with type one diabetes more often. Oddly, the male-female gender distribution out of all diabetes patients affected by Dupuytren's contracture is equal. A couple of mechanisms are said to play a role in this factor. Individuals with diabetes use insulin and oral hypoglycemics to help manage their disease, which may contribute to the development of the deformity. These medications can induce microvascular changes that may cause the area in the hand to become locally hypoxic. This local lack of oxygen triggers a chain reaction that can lead to the formation of the abnormal cord in the hand. Additionally, diabetes patients are more likely to suffer from peripheral nerve damage due to high blood sugar levels. Peripheral nerve damage contributes to the pathophysiology of Dupuytren's contracture.
It has been known for nearly half a century that epilepsy patients tend to have a higher incidence of Dupuytren's contracture than the average population. After investigation into this prevalence, the researchers came to the conclusion that epilepsy medication is the main cause. Prolonged administration of anticonvulsants can lead patients to develop Dupuytren's contracture. In the original study of epilepsy patients, fifty-six percent also went on to develop Dupuytren's contracture. The majority of the lesions were symmetrical and bilateral, and they tended to be associated with plantar nodules and knuckle pads. At the same time, the researchers didn't develop any known correlation between Dupuytren's contracture and frozen shoulder. During the study, patients appeared to have a heightened chance of Dupuytren's contracture regardless of what kind of epilepsy they had. At the time of the study, anticonvulsants other than phenobarbitone had only been introduced recently. The study indicated these anticonvulsants also increased a patient's chances of developing Dupuytren's contracture in addition to phenobarbitone.
Alcohol And Tobacco Consumption
Alcohol and tobacco consumption appears to increase an individual's chances of developing Dupuytren's contracture. There is a great deal of documentation regarding the ways smoking increases this risk. One theory behind this is that smoking leads to microscopic changes in the shape or walls of blood vessels. Studies have also been done regarding how alcohol consumption can increase an individual's risk of developing Dupuytren's contracture. The goal was to determine whether alcohol consumption itself leads to an increased risk, or if liver disease must play a part. There was a study done of five groups of patients in a hospital. Of the patients with alcohol-induced cirrhosis, or scarring of the liver, 32.5 percent had Dupuytren's contracture. In patients with chronic liver disease other than cirrhosis caused by alcohol, the prevalence was twenty-two percent. The portion was twenty-eight percent in those who had chronic alcoholism without liver disease, and the control group only had twelve percent. This indicates the consumption of alcohol increases an individual's risk of Dupuytren's contracture regardless of whether they have liver disease or not.