Dupuytren’s contracture (DC) is a hand condition where collagen under the skin of the palm and fingers forms thick cords. These cords shorten over time, pulling fingers toward the palm and preventing them from fully straightening. The ring finger is most commonly affected, followed by the little finger, but all fingers can be involved.
Causes and Risk Factors of Dupuytren’s Contracture
The exact cause of DC is still not fully understood, but several risk factors have been identified:
- Genetic Predisposition: Men over 50 of Northern European (Viking) ancestry have a higher incidence of DC.
- Manual Labor: Jobs that involve repetitive hand stress may contribute to DC in genetically predisposed individuals.
- Diabetes: People with Type 1 and Type 2 diabetes are at higher risk for DC. About 20% of diabetics develop DC, compared to 3-12% of the general population (Study on Prevalence).
- Additional Risk Factors:
- Alcoholism and smoking
- Epilepsy and certain medications, including barbiturates and HIV treatments
- Vitamin B-6, B-12, and D deficiencies
- Endocrine disorders, including hypothyroidism
The Link Between Diabetes and Dupuytren’s Contracture
Metabolic and Connective Tissue Changes
Chronic high blood sugar in diabetes leads to the formation of advanced glycation end products (AGEs), which can cause collagen stiffness and promote fibrosis in connective tissues (Nature Study).
Microvascular Issues
Diabetes-related vascular problems can affect blood flow to the hand, contributing to the development of DC.
Managing Diabetes to Reduce DC Risk
- Maintain Good Blood Sugar Control: This helps reduce collagen glycosylation and may slow DC progression.
- Diet and Exercise: A healthy lifestyle can improve overall connective tissue health.
- Supplements: Vitamin B complex, Vitamin D, magnesium, zinc, and calcium may support tissue health.
Treatment Options for Dupuytren’s Contracture
1. Surgery
Surgery involves removing the thickened collagen, which can be risky, including infection and nerve damage. Recovery can take weeks to months, often requiring physical therapy.
2. Needle Aponeurotomy
This technique, which uses a needle to break apart collagen cords through the skin, is a less invasive option. It is effective and has been used for over 30 years, but it may not prevent recurrence.
3. Xiaflex Injections
Xiaflex is an enzyme that dissolves collagen directly in the affected hand. After the injection, the fingers are straightened manually the following day.
- Clinical Trial Results: In a study of 306 patients, 64% had sufficient straightening to restore hand function.
- Side Effects: Possible side effects include temporary pain, bruising, swelling, and, in rare cases, tendon rupture.
- Cost: Xiaflex is approximately $3,250 per injection.
Special Considerations for Diabetic Patients
- Non-Surgical Treatments: Diabetic patients may benefit from less invasive treatments like Xiaflex to reduce the risk of complications such as poor wound healing.
- Ongoing Monitoring: Maintaining good blood sugar control is critical for diabetic patients due to the higher risk of recurrence.
Conclusion
Dupuytren’s contracture is a challenging condition, especially for individuals with diabetes. While advanced treatments like Xiaflex offer new hope, managing blood glucose and maintaining a healthy lifestyle are essential to reducing the risk of progression and recurrence.
For more information on managing diabetes and Dupuytren’s contracture, consult your healthcare provider or a specialist.