The palm of your hand

As a family physician living on the upper Great Plains, I have many patients of Norwegian and German descent. Thus, I am familiar with some diseases that are prone to affect people of northern European ancestry. One such example is Dupuytren’s contracture. 

Dupuytren’s contracture is a gradual thickening of the connective tissue of the palm of the hand. It may begin innocently as a nodule in the palm or joint stiffness, which are common for anyone. However, with Dupuytren’s contracture, over time the fingers curl inwards and cannot be straightened. Cords can become visible in the palm of the hand. This is often a slow progression over several years and may or may not become painful. It can make it harder to grasp objects and use the hand in general. 

Sometimes called the “Viking disease,” Dupuytren’s contracture most often affects men of northern European descent over the age of 50. Other risk factors making a person susceptible to this disease can include smoking, alcohol, manual labor and being thinner. It would seem being a fan of the Minnesota Vikings may be a risk factor, but that is probably just coincidence. 

The condition is named after Guillaume Dupuytren, a French military surgeon who was skilled in anatomy. He described the condition well and was the first to perform a successful operation for it in 1831. Interestingly, Dupuytren gained prominence from treating Napoleon Bonaparte’s hemorrhoids. 

Although a steroid injection or physical therapy may be helpful, in general, Dupuytren’s contracture cannot be cured, only treated. For a long time, surgery was the mainstay treatment, especially for more advanced cases. Surgery can involve cutting the fascia, the affected layer of connective tissue. A less invasive procedure involves using needles to weaken the thickened cords of fascia.

In the last decade a new treatment became available. Injecting the enzyme collagenase weakens the bonds in the collagen of the fascia, releasing the contractures. Extracted from the bacteria clostridium histolyticum, the collagenase offers an effective nonsurgical option for treatment. 

I am not sure what my Norwegian and German ancestors would have thought about injecting an enzyme from a bacterium into their hands. However, patients today appreciate regaining the use of their hands for daily activities and to clap and cheer for their favorite football team.

Andrew Ellsworth, M.D., is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow at http://www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its 20th season of truthful, tested, and timely medical information streaming live on Facebook most Thursdays at 7 p.m. central.