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Dupuytren’s contracture

Dupuytren’s contracture is a condition in which one or more fingers become permanently bent in a flexed position.[2] It usually begins as small hard nodules just under the skin of the palm,[2] then worsens over time until the fingers can no longer be straightened. While typically not painful, some aching or itching may be present.[2] The ring finger followed by the little and middle fingers are most commonly affected.[2] The condition can interfere with preparing food, writing, and other activities.[2]

The cause is unknown.[4] Risk factors include family history, alcoholism, smoking, thyroid problems, liver disease, diabetes, previous hand trauma, and epilepsy.[2][4] The underlying mechanism involves the formation of abnormal connective tissue within the palmar fascia.[2] Diagnosis is usually based on symptoms.[4]

Initial treatment is typically with steroid injections into the affected area and physical therapy.[4] Among those who worsen, clostridial collagenase injections or surgery may be tried.[4][5] While radiation therapy is used to treat this condition, the evidence for this use is poor.[6] The condition may recur despite treatment.[4]

Dupuytren’s most often occurs in males over the age of 50.[2] It mostly affects white people and is rare among Asians and Africans.[7] In the United States about 5% of people are affected at some point in time, while in Norway about 30% of men over 60 years old have the condition.[2] In the United Kingdom, about 20% of people over 65 have some form of the disease.[7] It is named after Guillaume Dupuytren, who first described the underlying mechanism in 1833.[7]

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