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Radiotherapy as a Treatment of Dupuytren's Contracture

Dupuytren’s contracture is a disease of the hand in which the fingers bend inwards and they cannot be extended to the fullest. This disease is heredity and an affected person can’t do anything to avoid it. The disease involves palmer fascia of the hand and it was named after a physician who had developed a technique to correct the problem. In most of the cases ring finger and little finger are affected, middle finger can also be affected in severe cases, but the thumb and index finger always stays safe. This disease spreads at a slow rate and it also doesn’t give you any pain. The patients that have got this disease experience their palmer fascia thickened and it also becomes short, such that the tendons that are connected to the fingers are not able to move in a free manner. The chances for appearance of this disease increase to a great extent after a human becomes more than forty years of age; men are mostly affected at this stage. In case of people above eighty years the gender distribution becomes even.

There are several symptoms of Dupuytren’s contracture and the most common one is that the palmer fascia becomes really thick; fingers bend inwards and are not able to function properly. In most of the cases small and middle finger are affected. Basic function of palmer fascia is to aid in gripping, with the passage of time the grip becomes loose and all this usually happens without causing any pain. Changes in collagen cause the palmer fascia to become really thick, it often starts with nodules in palm and may get extended to finger cords. Collagen of palmer fascia is type 1, but due to the disease it changes to type 3. The simplest method of diagnosing the disease is to place affected hand flat on a table top. If the hand lies flat, then the disease does not exist.

Dupuytrens treatment was first time done in the year 1831 by the aid of minimal invasive needle procedure, but due to instances of recurrence the treatment was shifted to surgery and even radiation therapy. Radiotherapy is basically a treatment in which either the disease is completely stopped or its rate of spread is controlled. X-rays are most commonly used in this technique of treatment. The nodules and cords that have been associated with the disease are irradiated from a short distance of around 0.5 to 1cm, x-rays used for this purpose are soft ones and they do not reach deep inside body. In some cases electrons are also used instead of x-rays. After a delay of one and a half month, the procedure is repeated. Radiation causes softness of the nodules and cords, which result in contraction of hand. A number of experiments have been conducted in this regard and it is found that smaller exposure to radiation also delivers good results.

The positive aspect of radiation therapy is that it may stop growth of nodules and cords on permanent basis or for a pretty long period of time. In some cases the small sized ones may even disappear. However, this method does not aid in straightening an already bent hand. The basic thing that determines the effectiveness of this treatment is the stage of disease, if it is done in the early stages it shows great results. Research has shown that a decade after therapy around eighty percent of the patients who just has cords & nodules, while sixty seven percent of the patients that had their hands bent by one to five degrees had either improved condition or the disease did not increase. Anyhow if this mode of treatment is not found successful, surgery is still an option. The only problem is that this mode of treatment is not practiced much in countries other than Germany and Austria.

Use of radiotherapy for Dupuytrens treatment has become the best method for all patients that are in the initial stages. The disease basically starts from the fiber made tissues as nodules; these are very active in the initial stage. Just like any wound healing process the tissues become mature and contract later on. The beginning active stage is the very best one for this procedure. Radiotherapy has proved to decrease the development of the growth factors. It has been seen that this happens as a result of affecting development pathway of the growth factors. Overall it has been acknowledged that this method of Dupuytrens treatment is highly affective for all patients that are in the early stage. Any person that has a doubt of having this disease should contact a qualified physician as soon as possible. If this disease exists in your family you would easily be able to notice if it hits you. Radiotherapy should be done as soon as the stage of the disease is determined, in this way you shall not just be able to get rid of the problem, but also avoid the painful surgery process.

In case the early stage is gone and Dupuytrens disease has reached more complex level surgery can be done in order to get rid of the problem. There are various methods of surgery in practice and in some cases doctors advise use of splints in order to maintain extension of finger that is attained after surgical process. There is no proper proof that use of splints has got positive affects and that is the reason why most of the surgeons decide the method of using splints on their experience of practice. On the other hand there are some surgeons that believe that splints may cause joint stiffness, increase in pain period after surgery and edema. The effects of splints are debatable; they are very costly and uncomfortable. Though this disease is not new, but due to its little occurrence extensive research is not found regarding it. Doctors are trying to have more evident findings by collecting facts from control groups and in future there are chances that much better methods of Dupuytrens treatment would be available for the affected persons.