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What Causes Pain in Dupuytren Disease?
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Posted on: 08/30/2012
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Most people with Dupuytren disease don't complain of pain. They are bothered much more by the loss of finger motion, especially extension (straightening the affected fingers). But sometimes the nodules that form are painful.
Dupuytren's contracture is a fairly common disorder of the fingers. It most often affects the ring or little finger, sometimes both, and often in both hands. The condition is noted to be secondary to an increase in fibroblast density, a complex biochemical and cellular interaction. The disorder may occur suddenly but more commonly progresses slowly over a period of years. The disease usually doesn't cause symptoms until after the age of 40.
Surgeons wondering why this condition becomes painful for some patients decided to investigate further. They also evaluated whether surgery would help (or make worse) painful symptoms in 10 patients.
Cords and nodules present as part of the condition were dissected (cut apart and removed) and then examined under a microscope. The tissue samples all contained some type of nerve tissue. Some had tiny nerve branches in or across the fibrous tissue. Other patients had nerve fibers embedded inside the nodules. Three patients had actual neuromas (bundle of nerves grown together where they don't belong).
Based on these findings, the surgeons suggested that nerve compression is the cause of painful Dupuytren disease. The fact that all patients were painfree after surgical removal of the tissue supports this theory.
They suggest early sugery for anyone with painful Dupuytren disease even if finger motion is fine. All tissue removed should be examined by a pathologist who will look for the presence of nerve tissue embedded within or crossing the fibrous cords. Correlating pain patterns with results of surgical removal (as was done in this small study) may help direct future treatment recommendations.
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References:
A. von Campe, MD, et al. Painful Nodules and Cords in Dupuytren Disease. In The Journal of Hand Surgery. July 2012. Vol.37A. No. 7. Pp. 1313-1318.
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