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| Dupuytren's Contracture |
Last updated: Jul 17, 2008 |
Contributing risk factors | Recommendations
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Dupuytren's contracture is caused when connective tissue in the palms and fingers becomes shorter and thicker bringing the fingers inward toward the palms. Baron Guillaume Dupuytren, a French surgeon, described the surgical treatment for the disease which now bears his name in 1832. While the cause of it is not understood well, some things have been learned in recent years.
Inheritance is the most important factor in this condition. 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 ages 50 to 70 years old.
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.
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.
Surgery has been considered the only treatment, and there are controversies over the type of procedure which should be used. In all methods of treatment currently used in standard medicine, there is a high rate of recurrence after what appears to be successful operations. 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, some doctors feel that delaying surgery until necessary may be the best course.
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.
Here is a link to a page about Dupuytren's and Plantar Fibromatosis by Dr. Alan Greene.
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 Risk factors for Dupuytren's Contracture:
Recommendations for Dupuytren's Contracture: | | | | | | Amino Acid / Protein |  Cysteine / N-acetyl-cysteine (NAC) | Here is some information from this site: http://www.dupuytren-online.info/research_projects_dupuytren.html
In laboratory experiments NAC can slow down growth of Dupuytren cells (Juergen Kopp et al. "N-Acetyl-L-Cysteine abrogates fibrogenic properties of fibroblasts isolated from Dupuytren's disease by blunting TGF-ß signalling" J. Cell. Mol. Med. 10 (2006) pp. 157-165, see also our page on NAC therapy. It is unclear to whether the laboratory concentration levels of NAC can be achieved in a real hand and to what extent lower concentrations would be beneficial. As far as we know there are no clinical results available about the effect of NAC on Dupuytren's contracture (Dupuytren's disease) or Ledderhose disease in real life. Therefore we, in cooperation with Dr. Charles Eaton of the Florida handcenter, collected reports from Dupuytren patients who are taking NAC or have taken NAC. Here are the results (data collection ended October 2007).
A total of 10 patients participated initially. Three patients stopped taking NAC (brand name e.g. ACC) after less than one month. Below are the reasons for stopping to take NAC:
- one patient because of continuing stomach problems after 1 week of NAC
- one patient because of permanent fatigue
- one patient for private reasons.
Patients' details:
7 patients have taken NAC for more than 1 month. Below percentages refer to a total of 7. Please note that a total of 7 doesn't provide very reliable statistics, the percentages are below thus not to be taken for granted. - All of those 7 patients were male.
Age: 42 - 60 (average = 51.5)
Stage of disease: all patients suffered from Dupuytrens, 43 % additionally from Ledderhose, 14 % also from Peyronie. Most patients had one or more surgeries already.
Dose: typically 600 mg NAC/day; 1 patient temporarily takes 1 g /day
Application period: 3 - 6 months.
Positive results:
- typically not much change in the first 2-3 months but situation stable
- after 3-5 months 86 % of the patients report that their nodules became somewhat softer
- one patient (14 %) reports that his Ledderhose nodules became softer after 3 months but that his Dupuytren cords kept growing slowly. Another patient reports of a growing cord after 5 months.
- one patient reports after 5 months that his Dupuytren nodule shrank to about 2/3 its initial size. Another patient reports after 3 months that his Dupuytren nodules became "somewhat smaller".
- one patient reports that his grip improved after 4 months.
Summary:
Taking NAC over 2+ months seems to soften nodules. Nodules seem to grow slower or might in favorable cases even shrink to some extent. Cords seem to continue growing but possibly slower. We have no reports what happens when taking NAC is discontinued.
A better controlled clinical research might make sense as next step. Dr. Eaton suggested that taking NAC orally might not be sufficient to achieve high concentration at the tumor itself. Other means of application might be more efficient and worth investigation.
Observed side effects:
One patient reported an initially aching stomach. See also above reasons for stopping to take NAC. |
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Diet |
 Dairy Products Avoidance| | Damage from xanthine oxidase, which is found in homogenized milk, was discovered in the palmar connective tissue of patients with Dupuytren's contracture. |
Vegetarian/Vegan Diet| | The most favorable diet is a totally vegetarian (vegan) diet - no meat, milk, eggs, or cheese. |
Therapeutic Fasting| | A period of fasting, at least 3-5 days, at the beginning of local treatment may be helpful. |
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Physical Medicine |
Ultrasound| | The use of ultrasound with heat has proved beneficial in some cases. Some cases have been effectively treated and corrected. Severely contracted hands will sometimes improve considerably. [Heat Therapy and Ultrasonics 208:125;1972 ] |
Physical Therapy| | Finger and wrist exercises have helped in trials. 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. |
Hot Applications| | Soak hands and wrists in hot water four times a day for 20 minutes each time, for two months. After the hands become warm, the fingers should be manipulated and stretched by firm massage with pulling or pushing motions. |
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Surgery/Invasive |
 Surgery| | There are now some surgeons in the United States that are performing a French technique called Needle Aponeurotomy, also called 'Needle Fasciotomy', in place of traditional surgery. Dr. Charles Eaton of Jupiter, Florida has performed over 800 of these procedures including one client who reports "My ring and little finger went from 30 degrees to completely flat in 45 minutes. I played golf 2 days later.". |
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KEY | | Weak or unproven link | | | May do some good | | | Likely to help | | | Highly recommended |
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