All About Dupuytrens Contractures

Contracture means tightening of the muscles or tendons which has lasted over a long period of time, leading to shortening. There are several causes of contractures. It is seen in people suffering from increased spasticity in certain muscles of the body for e.g. those suffering from conditions like spastic cerebral palsy. It could also be due to prolonged ischaemia of the involved muscles, for e.g. that seen in a condition called Volkmann’s ischemic contracture.

Volkmann’s Ischemic contracture was named so after Dr Richard von Volkmann who first described this condition. It is a condition caused due to prolonged ischemia of the muscles and nerves of the forearm. In cases where there is severe trauma to the forearm or a crush injury, there is swelling of the muscles and soft tissue this leads to pressure on the blood vessels and a condition called compartment syndrome. This leads to decreased blood supply to the muscles of the forearm. A decreased blood supply in turn leads to shortening and stiffening of the muscles of the forearm. Once the muscles contract, they deform the joint over which they pass. Thus there is a permanent flexion contracture at the hand and the wrist joint resulting in a claw like deformity of the hand and the fingers. It is more commonly seen in children. Passive extension of the fingers is restricted and causes severe pain. In such cases the radial pulse may often be absent and the fingers are white or blue in colour and cold to touch. Treatment involves surgical release of the stiffened and fixed tissues. The compartment pressure must be relieved by removal of all splints, plasters or bandages which may be hampering the circulation and a fasciotomy may be helpful in initial cases. Surgery is done to release the flexors of the forearm and tendon lengthening.

Burn scar contracture refers to contraction and tightening of the skin following second or third degree burns. Following burns there a contracture develops as the surrounding skin begins to pull together. It must be treated as soon as possible as it may cause restriction of the movement in the surrounding area. Treatment involves skin grafting.

Dupuytren’s Contracture also known as Dupuytren’s disease is another common type of contracture. It was named after Baron Guillaume Dupuytren who first described the surgery for correction of this Contracture. It is a fixed flexion contracture of the hand where the fingers get fixed in a position of flexion, making extension impossible. This condition develops due to contractures of the palmar aponeurosis or palmar fascia. The ring finger and the little finger are most affected, the middle finger is affected in severe cases and the thumb and the index fingers are mostly spared. It is a condition that develops slowly and is painless. The tissues beneath the palm stiffen and become thick, leading to impaired movement of the tendons. The palmar aponeurosis becomes thick hyperplastic and undergoes contracture.

Capsular contracture is another type of contracture. It is caused due to an abnormal response of the immune system to foreign materials or implants in the body like breast implants and artificial joint prosthetics.


Similar Posts:

GD Star Rating
loading...
GD Star Rating
loading...

Leave a Comment