Dupuytren's contracture, also known as palmar fibromatosis, a is progressive condition which results in one or more fingers becoming bent in a flexed position. This is due to a shortening of the palmar fascial bands, causing flexion deformities of the fingers. Fascial bands are made of connective tissue, primarily collagen, located beneath the skin they attach, stabilizes and enclose the internal structures throughout the body - holding us together. Fascial bands are usually tough but pliable.
Dupuytren's contracture occurs over time and usually begins with a gradual thickening and hardening of the facial tissue located just under the skin of the palm of the hand. This can be felt as small hard nodules or knots of tissue, which eventually form into a thick cord loosing its pliability and pulling the associated fingers to bend towards the palm. The contracture of the fiber's worsens over time until the fingers can no longer be straightened. The 4th or ring finger and small 5th fingers are the ones mostly affected. Physical therapy, diet and nutrients can help.
The development of Dupuytren's contracture
The development of Dupuytren's contracture involves fibroblast proliferation and collagen deposition leading to contractures of the palmar fascia (the tissue of the palm of the hand).
Fibroblasts are a type of biological cell which synthesize the extracellular matrix and collagen, producing the structural framework of tissue. In other words – an increase of the cells which form the collagen tissue of the palm of the hand.
The extracellular matrix (ECM) is one of the most important regulators of cellular and tissue function, when homeostasis is lost the result can be the formation of excess fibrous connective tissue.
Fibroblast also function as accessory cells in many immune and inflammatory responses.
The nodules or knot found in Dupuytren's disorder are full of contracting cells, called myofibroblasts and rich with immune and proliferating fibroblastic cells. This is considered to be representative of active disease.
The fascia of the palm is made of Type I Collagen, but with Dupuytren’s Contracture, this changes from type 1 to Type III Collagen, a thicker type of collagen.
Pathogenesis Dupuytren’s disease
Although the exact pathogenesis Dupuytren’s disease is yet to be explained, immunological, genetic and cellular interactions are considered likely factors.
Risk factors
- Males
- Over 50 years in age
- Those of eastern Europe descent (the disorder is also known as Vikings due to the common occurrence in people from the Norwegian region)
- Family history (genetics)
- Smoking
- Alcohol use
- Diabetics
- Epileptics – possible due to anti-seizure medication
- Heavy work
- Medication – such as anti-epileptic or anti-seizure medication
The genetic connection, often misses a generation. Risk of development of the disorder is higher and initialed usually through one or many stressors. These might include general aging, heavy alcohol use, smoking, some medications, diabetes and physical labour. Sometimes the stressor may not be identified.
Management of Dupuytren’s disease
The most effective management of Dupuytren’s disease is early recognition and treatment of the nodule, before the development of a joint contracture. As there is evidence of a significant inflammatory role in the development of the nodule, using means to minimized or reduce inflammation by altering the macrophage > fibroblast > collagen cascade is considered most important.
Medical treatments consist of corticosteroid injection, surgery, or injections of clostridial collagenase. Collagenase clostridium histolyticum is an enzyme produced by the bacterium Clostridium histolyticum which breaks-down collagen.
Naturopathic suggestions
Magnesium
Many people are deficient in magnesium, but particularly diabetics, alcoholics and those with liver disease. Magnesium plays an important roles in the body, such as calcium regulation and muscle relaxation. Low levels are considered a stressor. Magnesium may be able to relax the tissue affected in the first stage of disease pathology but is ineffective in second stage. It can be taken orally and/or applied topically directly to area affected. Note. Some people find the dry salt residue left from topical application irritating to the skin.
Bromelain is a proteolytic (protein digesting) enzyme found in pineapple fruit useful in its ability to break-down tissue fibres, and in the case of Dupuytrens disease, collagen protein. It does this by stimulating the enzyme, collagenase, which breaks the peptide bonds of collagen.
Turmeric/curcumin can suppress pro-inflammatory pathways linked with most chronic diseases.
Omege-3 fatty acids. Fish oil has anti-inflammatory properties and may help with conditions involving chronic inflammation.
Vitamin E. Some studies have found taking 300 mg vitamin E mixed tocopherols down-regulated fibroblast activity in the early stages of the disease (fibrosis of the palmar fascia without contractures), resulting in improvement and in some cases total resolution.
Vitamin B6. The active form of vitamin B6, pyridoxal 5'- phosphate (PLP) is the active form of vitamin B6. It serves as a co-factor in more than 150 enzymatic reactions. In cases of inflammatory conditions, blood test have revealed consistently low levels of plasma PLP.
Echinacea. There is a conncection to immune regualtion and Dupuytren's contracture. Echinace is a herbal medicinal useful in immune modulation has also been shown to have an action on reducing inflammation.
Physical therapies
Hand exercise and physical therapy can help give relief and improve recovery.
Massage using instrument-assisted cross-frictional massage (CFM) and stretching over an 8-week period resulted in increases in “both passive and active extension range of motion of the digits, reduction in the visibility of palmar adhesions and subjective improvements in hand function”[1].
Reduce or avoid activities which cause pressure or strain on the hands. Talk to your doctor or physiotherapist for advice on appropriate exercises.
Diet
Magnesium-rich foods include banana, figs, avocado, green leafy vegetables (kale and spinach); Vegetables (peas, broccoli, cabbage, green beans, artichokes, asparagus, brussels sprouts); Seafood (salmon, mackerel, tuna); cocoa, nuts (almonds, cashews, brazil nuts; seeds flax, chia, pumpkin) legumes and tofu.
An anti- inflammatory diet which includes fresh fruit and vegetables, clean sourced protein such as wild salmon, organic chicken and eggs and grass-fed beef. Healthy fats from olive oil, ghee, grass-fed butter from grass-fed animals, nuts and seeds, coconut and avocados.
Sugar reduction. Avoid excess sugar and processed carbohydrates. If diabetic, strict monotoring of blood sugar is important to avoid damage to small blood vessels.
Reduce sodium and sodium containing foods. Sodium (salt) can increase fluid retention causing swelling.
Quit smoking
Smoking contributes to inflammation and can lead to microscopic changes in blood vessels and tissue. People who smoke are at increased risk of developing Dupuytren’s contracture.
References
- Recent advances in the understanding of Dupuytren’s disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396840/
- https://www.mayoclinic.org/diseases-conditions/dupuytrens-contracture/symptoms-causes/syc-20371943
- https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/hand-disorders/dupuytren-contracture?query=dupuytren%20contracture
- https://dupuytrens.org/magnesium-and-dupuytren-disease/
- https://en.wikipedia.org/wiki/Dupuytren%27s_contracture
- The Rationale for Treating the Nodule in Dupuytren’s Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4292260/
- https://en.wikipedia.org/wiki/Collagenase_clostridium_histolyticum
- https://www.healthline.com/nutrition/10-foods-high-in-magnesium#section8
- https://www.huffpost.com/entry/magnesium-alterative-medi_b_10296538
- https://draxe.com/health/dupuytrens-contracture/
- Curcumin: an orally bioavailable blocker of TNF and other pro-inflammatory biomarkers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753829/
- Omega-3 fatty acids and inflammatory processes: from molecules to man. https://www.ncbi.nlm.nih.gov/pubmed/28900017
- Inflammation, vitamin B6 and related pathways. https://www.ncbi.nlm.nih.gov/pubmed/27593095
- A new bromelain-based enzyme for the release of Dupuytren’s contracture https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4921045/
- [1]Cross-frictional therapy and stretching for the treatment of palmar adhesions due to Dupuytren’s contracture: A prospective case study https://www.sciencedirect.com/science/article/abs/pii/S1356689X11001925?via%3Dihub
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