You may not have heard of connective tissue, but you have an awful lot of it. Tough, non-stretchy fibres connect our bones to each other or muscles to bones. Without it, we would literally fall apart. But sometimes connective tissue connects things too tightly - and the result can be a peculiar but common condition called Dupuytren's contracture.
What is it?
Dupuytren's contracture affects one (or more often both) palms of your hands. It usually starts with a thickening of the connective tissue on the palm of your hands, and this may be the only symptom you ever get. If the connective tissue continues to tighten up, however, over months or years it can bend your fingers forward like a claw, forming a 'contracture'. The first finger affected is usually your ring finger, then your little and possibly later your middle finger. It doesn't hurt but it stops you straightening your fingers out, which can make it hard to carry out tasks with your hand that you used to take for granted.
Who gets it?
Dupuytren's usually starts when you're over 50, and is more common in men than it is in women (about one in six men in the UK have it to some extent). It often runs in families, and is more common in people from Northern Europe than anywhere else. Both Margaret Thatcher and Ronald Reagan suffered from it, but this doesn't mean that being a politician makes you more prone to getting it!
Do I need to get it looked at?
Many people only get mild thickening under the palm, and you may not need any treatment if this has happened to you. However, if you can't straighten your hand out, or if it's having an impact on your day-to-day life, see your GP to talk about referral to a hand specialist.
Will I need surgery?
You won't need treatment unless your fingers, or the joint between your hand and your fingers, can't straighten. Radiation (X-ray) treatment and splinting are both occasionally recommended, but clearly radiation treatment isn't suitable for everyone. In one study of radiation treatment, over half of people treated showed improvement at one year and in another, two thirds still had some benefit after 13 years. Side effects include dry and flaking skin on the hand.
Most people needing treatment are offered surgery. A minor form of surgery, done under local anaesthetic within a few minutes, involves putting a sharp needle through the skin and sawing away at the tough connective tissue with the edge of the needle. However, while complication rates are low (about one in 100 people get some complication), three in five people find their symptoms have returned within three to five years. Otherwise, the tissue can be cut open or removed. Success rates are higher than with the more minor needle procedure, but so are complication rates at about one in 20 people having the operation. Obviously, all surgery carries some risk and your specialist will talk to you about the best options.
What doesn't work - and what may if you can pay for it
Several alternatives to 'traditional' surgery have been looked at for Dupuytren's. The effectiveness of ultrasound treatment and vitamin E cream rubbed on to the hand have both been assessed. The National Institute for Health and Care Excellence (NICE) doesn't recommend either of these, on the basis that there isn't enough medical trial evidence to support their use.
A new non-surgical treatment has been licensed in the last couple of years for some people in the UK with Dupuytren's contracture. It involves injecting an enzyme straight into the connective tissue to break it down. It can be done in an outpatient clinic when you see your specialist. If the first treatment doesn't work, you can have the treatment repeated up to three times, a month apart. In one study almost two thirds of people treated had a good result. However, it's not routinely available on the NHS yet (some private hospitals do offer it).
Carpal tunnel syndrome - making the connection
Carpal tunnel syndrome is another problem caused by the connective tissue in your hand, but in this case it's the thick band of connective tissue on the front of your wrist. Between this band and the bones of your wrist runs your median nerve - which controls sensation to your thumb and the thumb side of the palm, as well as some movements of your thumb. If this nerve gets squashed, you can get pain, pins and needles, numbness and sometimes weakness in this part of your hand.
If your symptoms are mild, as with Dupuytren's, it may not need any treatment other than rest. Wearing a wrist splint at night, or a steroid injection into the carpal tunnel area, may also do the trick. If they don't, a minor operation (usually done under local anaesthetic) to open up the band of connective tissue is highly likely to cure your symptoms.
With thanks to 'My Weekly' magazine where this article was originally published.