In 1994, Gina discovered some small nodules in the palm of her right hand, which her surgeon removed. By 1999 the nodules appeared in her left hand, again with local anesthetic and surgery her hand was quickly back to normal. Late last year, barely one year later, the nodules recurred in both hands, and this time she was given full anesthetic for the surgery.
"When the nodules appear, you can feel them and there is discomfort in driving, mopping, sweeping or any activity that puts pressure on the palm" said Gina, who recovered the use of her hands very quickly after the first and second surgeries, not so the third, which has left her vowing "no more surgery, no matter what."
In chatting to an orthopaedic surgeon about this disease, called "Dupuytren's Contracture" he was sure that should there be a recurrence, which is quite possible, and it gets to the stage where Gina's finger bends inwards until it is flat against the palm of her hand, she will agree to surgery "because if unattended the skin under the bent finger can become ulcerated and she could possibly lose that finger."
Dupuytren's occurs mostly after middle-age, usually in the male of the species, is most common in people of European descent and may be inherited. It can also occur in epileptics taking phenytoin, alcoholics with cirrhosis and diabetics.
In simple layman's language, the surgeon explained that "it is thought to be a problem in the fibrous tissue under the skin in the palm of the hand. It may also affect the soles of the feet and a few very similar conditions occur in other parts of the body."
In Dupuytren's, which can occur in both hands, although one is usually more marked, the condition starts off with little nodules in the palm, puckered and thick. Pain may occur but is seldom a marked feature. The only treatment is operative but it does not cure the condition. It will just remove bands that may cause deformity of the fingers or are particularly painful. Since the removal of the bands is difficult and they commonly recur, surgery is not performed in all cases.
"It is not something you will get rid off. Once you have it you have it" stressed my consultant "you may remove the band but it can recur and for some people even more aggressively after you operate. And as well having done the surgery once, it is usually harder to do it a second time."
Having excised the bands, treatment includes stretching, exercises, splints and massage oil baths for up to three months after, but there is usually a rapid return to normal function if it has been done at the right time. If the band is left unchecked there will be severe contracture and operative treatment is extremely difficult so that treatment should begin before the finger bends, because it can actually lead to amputation.
Luckily Dupuytren's is not that common in Trinidad & Tobago's coloured population "although you do see cases every now and again" says the Orthopaedic Surgeon "as recent work has revealed a marked increase in fibro-blast density, which is a disorganised pattern of collagen distribution and microvascular constriction in the fibrous cords of the contracture."
It is believed that the cells that form fibrous tissue made up of fibrous bands undergo fibrotic changes due to the action of oxygen- free radicals, which are oxygen molecules that can attach to any compounds around and can have a damaging effect by changing the nature of the compound.
Dupuytren's commonly starts with the ring finger which will bend, then the little finger, followed by the others.