palmar fibromatosis

Dupuytren's contracture

Dupuytren's contracture (also called Dupuytren's disease, Morbus Dupuytren, Palmar fibromatosis and colloquially Viking disease, Viking hand or Celtic hand) is a condition in which one or more fingers become permanently bent in a flexed position. It is named after Guillaume Dupuytren, who first described the underlying mechanism of action, followed by the first successful operation in 1831 and publication of the results in The Lancet in 1834. It usually begins as small, hard nodules just under the skin of the palm, then worsens over time until the fingers can no longer be fully straightened. While typically not painful, some aching or itching, or pain, may be present. The ring finger followed by the little and middle fingers are most commonly affected. It can affect one or both hands. The condition can interfere with activities such as preparing food, writing, putting the hand in a tight pocket, putting on gloves, or shaking hands. The causes of Dupuytren's contracture are not completely understood. The disease is driven by over-activation of fibroblasts and myofibroblasts in response to signaling molecules including IL-1 beta, TGF-beta, EGF, and CTGF, leading to inappropriately increased formation of fibrous connective tissue. Risk factors include family history, smoking, thyroid problems, liver disease, diabetes, previous hand trauma, and epilepsy. The development of Dupuytren disease has also been associated with environmental factors, including smoking, alcohol consumption, aging, trauma, and repetitive use of the hand in certain physical occupations. Genetic studies...