Dupuytren’s Contracture
Dupuytren’s contracture is a hand deformity, usually developed over the span of a few years. It is a relatively common problem found mostly in men, but can also be developed by women. It often begins as the thickening of the skin on the palm of your hand and progresses into hard lumps growing in the palm of the hand, usually in the ring or small finger area. These lumps eventually form cords that start to contract the fingers into the palm so that individuals cannot straighten their fingers out, this is where the deformity is generated.
While it may appear upon first glance that the condition may be painful, it does not actually cause pain to those inflicted. There is a genetic component to the disease that was discovered, centralizing in people from northern European descent, and in the British Isles. In the past, it has been referred to as the “Viking’s disease” due to this correlation.
While it does take some time for this condition to develop, treatment is warranted once a contracture of the fingers starts to occur. There are a few ways to treat and address this issue, including injections of a collagenase material that can help patients who contain specific patterns of cord formation within the affected hand.
If the contracture continues to advance, surgery is usually needed to resolve the issue. Operative care involves excising the Dupuytren’s material under the skin and then suturing the skin back up. Hand therapy after this surgery is complete is very important to obtaining a good outcome. Often patients will need to wear splints at night for 6 months to help prevent and recurrence of the disease.
Ganglion Cysts
Ganglion cysts can occur in many locations throughout the hand, wrist and forearm, there is typically a pattern of places the cysts seem to prefer to form. Wrist ganglion cysts are very common, and most frequently occur at the area of the palmar side of the wrist where one takes a pulse. They can also form at the back of the wrist right in the middle, which is referred to as volar and dorsal wrist ganglions respectively. Another common location is on the nail side of the finger at the last joint, located right below your fingernail. This type of ganglion cyst is known as a Mucous Cyst. Mucous cysts, if present for a time, will cause a groove of the nail plate to occur which will resolve after the cyst is removed
All ganglion cysts occur over joint areas, as the fluid that fills the ganglion comes from the joints. In the wrist area, the cysts can occasionally resorb spontaneously or can be aspirated with a needle. If this treatment does not work, they can be excised, but this usually is not necessary as there is a low recurrence rate.
In the finger, the mucous cyst is always caused by a bone spur and some level of arthritis located in the last joint of the finger. These types of cysts nearly always need to be excised. It is important for your doctor to remove the bone spur as well during the procedure, as this technique helps prevent recurrent cysts from appearing.
Dr. Arnold Peter Weiss is the R. Scot Sellers Scholar of Hand Surgery; Chief of Hand Surgery; Vice Chairman & Professor, Brown University.