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Dupuytren's contracture



What is Dupuytren's Contracture?

Slowly a finger, or fingers, is drawn down toward the palm or wrist. This action is caused by the connective tissue in the palms and fingers becoming short and thick, too short and thick to allow free movement of the fingers. Baron Guillaume Dupuytren, a French surgeon, described the surgical treatment for the disease now bearing his name in 1832, and reported it in Lancet in 1834. The cause of it is not understood well, but some things have been learned in recent years.

Surgery has been considered the only treatment, and there are controversies over the type of procedure which should be used. Should it be an extensive excision or limited excision of the connective tissue in the palm and fingers? And when in the progress of the disease is it best to operate, early or late? And there is controversy over whether the wound should be left open or closed after the surgery.

In all methods of treatment currently used in standard medicine, we find a disappointingly high rate of recurrence after what appears to be successful operations. We believe alternative methods should be applied as soon as the first symptom appears. Every attempt should be made to arrest the progress of the disease before it becomes disabling. However, if natural remedies fail to halt the disease, we believe delaying surgery as long as possible to be the more desirable course


Causes

Inheritance is the most important factor; Whites, especially those of Celtic origin, have the highest incidence, and it runs in families. It is uncommon in pigmented races, and males are at least twice as often affected as females, in some reports as high as 7 to 1. The peak incidence is between the fifth and the seventh decades of life.

High blood fats (cholesterol and triglycerides) have been associated with Dupuytren's disease.1 Ideal blood lipid levels are 100 plus the person's age for cholesterol, and the same as the age for triglycerides. Several associated diseases have been observed, including epilepsy, diabetes, alcohol abuse, heart disease, and pulmonary disease. Note that each of these diseases is usually treated with powerful drugs, which may unite their metabolic disturbances with the metabolic disturbance of the disease to cause growth of the connective tissue in the palms and fingers.

One study showed alcoholics have a higher rate of this disease than others-28 per cent as compared to 8 per cent.2 Several studies have indicated an association between some kind of immune disorder and Dupuytren's contracture in susceptible persons.3

Type II diabetes (adult onset) with absent or reduced insulin receptors on cells of the palmar connective tissue, with a disturbance of the smallest blood vessels and nerves, (micro angiopathy and neuropathy), as well as cigarette smoking, and other factors such as barbiturate use, promote the development of connective tissue disorders.4,5,6


Ideal Blood Lipids
Cholesterol = 100 plus your age
Triglycerides = Your age



It was once thought occupational trauma and Peyronie's disease, a male genital tract disease, were factors, but now are recognized not to be factors. Yet, the right hand is more often affected, the ring finger (forth) being most often involved, followed by the small, middle, and index fingers.

Physical forces, such as electrical fields, seem to be indicated by some research in causing Dupuytren's contracture. Electrical fields have had bad press in many areas, also including cancer.7 The younger the patient, the more rapidly it progresses. The commonest first sign is a fleshy nodule in the palm, usually located at the base of the ring or small finger in the crease where the finger joins the hand. The nodule may be painful or itch, and may reach one half inch in diameter. It is followed by puckering of the skin of the palm over the involved tendon.


Treatment

Several treatments have been tried and failed to alter the course of the disease, including vitamin E, steroid injections, radiation therapy, ultrasound, and splinting. It has been said that successful conservative treatment is possible only at the very beginning of the disease.8 Nevertheless, at whatever stage you are, we recommend the following home remedies be applied very carefully:

The most favorable diet is a totally vegetarian diet-no meat, milk, eggs, or cheese. Damage from xanthine oxidase, which is found in homogenized milk, was discovered in the palmar connective tissue of patients with Dupuytren's contracture. Xanthine oxidase has also been found in the joints of both normal and rheumatoid joints, suggesting these joints may be the target of damage by free radicals promoted by this enzyme.9

Use no free fats-margarine, mayonnaise, fried foods, cooking fats, salad oils, or nut butters. Free fats cause tissue proliferation in certain diseases (cancer and skin lesions), and could be a factor. Free radicals are compounds with unpaired electrons, making them chemically active. Since they are not harnessed in any way, they can shoot around and cause damage. They are developed from fats, and play a part in inflammation, autoimmune diseases, and possibly help cause Dupuytren's contracture.10 Be regular in your schedule-especially with mealtimes, bedtimes, etc.

Do physical exercise to tolerance, at least 6 days a week. This should be done with religious consistency. Finger and wrist exercises have helped in trials using also heat and massage.11 Get a sponge ball from a toy department and try to make your thumb meet each finger, one by one, through the sponge ball using a pinching motion. Begin with five repetitions with each finger, and build up to twenty. Then squeeze the ball as firmly as possible, and while holding the squeeze tightly, slowly bend the wrist up and down as if waving goodbye.

Soak hands and wrists in hot water four times a day for 20 minutes each time, for two months, and after the hands become warm the fingers should be manipulated and stretched by firm massage and pulling or pushing. The use of ultra sound with the heat has proved beneficial in many cases.12 Some cases have been effectively treated and corrected with ultrasound. Severely contracted hands will sometimes improve considerably.13

A long period of fasting, 3 to 5 days, at the beginning of the treatment may be helpful. This should be followed by a diet sufficient to keep the blood sugar between 70 and 85, the blood pressure under 120/80, and the blood cholesterol and triglycerides in the ideal range.

If hypertension is also present, the patient should be given a very strict routine of blood pressure control. (See our Blood Pressure book.)

While free fats and oils of all kinds should be removed from the diet, nuts, seeds, avocadoes, and olives, may be used as desired. All free sugars should also be removed from the diet such as sugar, honey, syrup, molasses, etc. Fruits may be eaten freely, however


Reference

1. Journal of Bone and Joint Surgery 74B:923-927, November, 1992
2. Journal of Hand Surgery 17:71-4;1992
3. Journal of Hand Surgery 16:267-71; 1991
4. Diabetes Research and Clinical Practice 11:121-5; 1991
5. Archives of Internnal Medicine 149:911-4; 1989
6. Journal of Hand Surgery 11:463-4; 1986
7. Annales de Surgery Chirugie de la Main et du Membre Superieur 11(5):355-61;1992
8. Seminars in Arthritis and Rheumatism 3(2):155;1973
9. British Medical Journal 296:292-293;1988
10. Journal of Bone and Joint Surgery 70-B:689;November 1988
11. Journal of American Geriatrics Society 16:531; 1968
12. Heat Therapy and Ultrasonics 208:125;1972
13. Physiotherapy 66:55; 1980






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