francois j duminy
Plastic & Reconstructive Surgeon
CAPE TOWN PLASTIC SURGEON CV
Du Puytren's Palmar Contractures are brought about by the thickening and contraction of the fibrous tissue of the fascia in the palm of the hand.
The tight bands felt in the palm are not tendons and they dont have any function. They are a manifestation of the fact that injury or stress to healing fibrous tissue causes more fibrous tissue to form and subsequent contracture of fibrous tissue resulting in these troublesome bands.
The problem starts with a tiny injury to the palmar fascia, most commonly involving the Little finger or the Ring finger. Continued use of the hand then leads to the build-up mentioned above. This may be one of the reasons why it is more common in manual workers and in those who practice "handle" sports such as golf, tennis, cycling.
It is said that descendants of ancient Scandinavians have a greater propensity to develop this problem.
If the bands are not causing any problem, no treatment is required.
Treatment is aimed at releasing or removing the offending bands to improve function of the hand.
In the past, we usually operated on the hand and excised the bands, but more recently we have found that a large number of patients can benefit significantly from simple division of the bands using the tip of a needle.
There is now also the possibility of injecting an enzyme "collagenase" which helps to soften and break down the bands.