Hand Degeneration
Dupuytren's contracture
The skin of the palm of the hand is a very specialised structure to compensate for the large shearing forces which act upon it when the hand holds various items. If the skin were lax, as in other parts of the body, it could stretch during grip and the item slip out of the hand. To prevent this the skin in the palm is attached to a strong sheet of fibrous fascia, the palmer fascia, which underlies the skin in the palm and is attached by fibrous strips to the bones of the hand.
Occasionally this normally pliable sheet of fibrous tissue develops a thickening in line with one or more of the rays of the hand. This thickening may take several years to develop but as it does so it contracts and shrinks causing puckering of the skin along its length. If this contracture crosses into a finger it will cause it to be pulled slowly into the palm, which will ultimately cause a functional impairment of the hand.
This condition is more common in males and is found almost exclusively in Caucasian people originating in the Northern hemisphere. It is common for the condition to run in families and usually arises with no obvious precipitating event. Some factors, however, are associated with the condition and may contribute to its onset. These include diabetes, smoking, excessive alcohol ingestion, epilepsy.
The only effective treatment is surgical. During the procedure the thickened tissue under the skin is excised, along with its extensions into the finger. Mostly the results of this operation are satisfactory but problems can arise. The nerves to the finger are often tied up in the thickened tissue and can be injured during the operation. In this event an area of numbness in the finger can result. Occasionally there can be problems with healing of the wound. As an infrequent event, the contracture can recur. In these instances further surgery may be necessary.
Ganglion cysts
Ganglions are benign fluid filled cysts arising in association with tendons and joints, particularly around the wrist. The cause for these cysts is not clear but it is felt that, in some cases, herniation of the lining membrane from the joint is responsible. This possibly occurs following a localised injury to the joint capsule.
The cyst often varies in size. This, in itself, is not serious. Problems, however, can arise from the pressure effects such a swelling on the surrounding tissues and it is usually these which prompt people to seek medical attention. As the cyst increases in size it can become painful. A large tense cyst can interfere with the movement of an associated joint. Occasionally pressure of the cyst on a nerve can cause neurological symptoms.
Ganglion cysts can be injected with various sclerosing substances, after removal of the fluid, but this technique is associated with a relatively high rate of recurrence. The rate of recurrence is much lower with surgical excision and, while there is a small chance of damage to the small nerves in the skin in the area, this is considered the best form of treatment for this condition.
