Signs and Symptoms
2) Signs and symptoms: As mentioned in the definition, this condition usually arises in the middle ages on the side of the palm opposite the thumb. The patient usually first notices a painless small hard lump below the skin in the mid palm at the base of the ring or little finger. As the disease progresses, the overlying skin becomes increasingly puckered and rough bands of thickened tissue can be felt over the affected area. The first and second joints of the affected finger eventually become pulled down from the thickening and contracture of the tissue. The patient may complain that he/she cannot straighten the ring and little fingers, or that there is "a knot in my palm". The distal (farthest from the palm) joint remains unaffected. The joints themselves remain unaffected, but in long-standing cases the joints can become stiff from limited motion. The severity of the contracture varies from patient to patient and even in the same patient as the disease may progress. In more severe cases, the middle, index, and long fingers and even the thumb can become affected. The order of most common involvement of the fingers is: ring, small, long, thumb, then index. The patient may notice thickening over the dorsal (back) side of the finger joints (termed knuckle pads). If the patient's foot (feet) is (are) involved, this usually takes the form of of a firm nodule under the instep of the foot. A case has been described in which the disease extended beyond the wrist into the forearm. Some patients first notice the nodule or thickened tissue after an injury to the palm area. However, no clinical correlation has ever been demonstrated between injury and the development of this condition.
- Possible causes: As mentioned earlier, there has been an association of this condition with systemic diseases (for example, diabetes), epilepsy, Celtic races, and chronic alcoholism. However, this may be more coincidental than an actual cause and effect relationship between these entities. There is no known relationship in most cases and is therefore idiopathic (unknown cause). There has been a case described in the literature of Dupuytren's contracture arising in a patient following burns to the upper extremity. the authors concluded that burns of the upper extremity should be considered as a trigger to the onset of Dupuytren's contracture. A recent article found an increased risk of Dupuytren's contracture in smokers, stating that this may contribute to the association with with alcoholism, given the fact that many alcoholics tend to smoke heavily.