Dupuytren’s Contracture | Johns Hopkins Medicine

What is Dupuytren’s contracture?

Dupuytren’s contracture (also called Dupuytren’s disease) is an abnormal thickening of fascia, a layer of tissue under the skin, in the palm of your hand at the base of your fingers. This thickened area may develop into a hard lump or thick band. Over time, it can cause one or more fingers to curl (contract), or pull sideways or in toward your palm.

The ring and little fingers are most commonly affected. In many cases, it affects both hands. Rarely, feet may also be affected.

What causes Dupuytren’s contracture?

Dupuytren’s contracture is believed to run in families (be hereditary). The exact cause is not known.

It may be linked to cigarette smoking, alcoholism, diabetes, nutritional deficiencies, or medicines used to treat seizures.

Who is at risk for Dupuytren’s contracture?

You may be at greater risk for Dupuytren’s contracture if you:

• Are older.  The condition usually starts in middle age.
• Are male. It is more common in men than women.
• Have a Scandinavian or Northern European background. It is most common in people whose families come from these regions.
• Have a family history. The condition is often found in families, so it may be inherited.
• Take seizure medicine. It is linked with some medicines used to treat epileptic seizures.
• Smoke or abuse alcohol
• Have diabetes

What are the symptoms of Dupuytren’s contracture?

Common symptoms may include:

• Not being able to lay your hand flat on a table, palm down (called the tabletop test)
• One or more small, tender lumps (nodules) in the palm. Over time, the tenderness usually goes away.
• The nodules may thicken and contract or tighten. This can cause thick bands of tissue under the skin in the palm of the hand.
• Pits or grooves in the skin compressed by the contracted finger. These areas can become very sore and can lead to skin loss if they don’t heal properly.
• Fingers are pulled forward
• Your hand is not able to work as well

The symptoms of Dupuytren’s contracture may look like other health problems. Always see your healthcare provider for a diagnosis.

How is Dupuytren’s contracture diagnosed?

Your provider will examine your hand. He or she will test the flexibility and feeling in your thumb and fingers. Your grip and pinch strength may also be tested.

Your provider will measure and record the locations of nodules and bands on your palm. Using a special tool, he or she will measure how much your fingers are curling or contracting. Range of motion in your fingers may also be measured.

These measurements will be compared to later measurements to see if the disease gets any worse. They can also be used to see if treatment is working.

How is Dupuytren’s contracture treated?

Your healthcare provider will create a care plan for you based on:

• Your age, overall health, and past health
• How serious your case is
• How well you handle certain medicines, treatments, or therapies
• If your condition is expected to get worse
• What you would like to do

There is no cure for Dupuytren’s contracture. The condition is not dangerous. Many people don’t get treatment. But treatment for Dupuytren’s contracture can slow the disease or help ease your symptoms.

Treatments for Dupuytren’s contracture may include:

• Surgery. This is the most common treatment used for advanced cases. It may be done when you have limited use of your hand. During Dupuytren’s contracture surgery, the surgeon makes a cut (incision) in your hand and takes out the thickened tissue. This can improve the mobility of your fingers. Some people have contractures return. They may need surgery again.
• Steroid shot (injection). If a lump is painful, a steroid injection may help ease the pain. In some cases, it may stop your condition from getting worse. You may need repeated injections.
• Radiation therapy. This treatment is not as common in the U.S. Low energy X-rays are directed at the nodules. This works best in the early stage of the disease. It can soften the nodules and help keep contractions from happening.
• Enzyme injection. This is a newer, less invasive procedure done by specially trained surgeons. Your doctor injects a medicine into the area to numb the hand. Then the enzyme is injected into the lump of tissue. Over several hours, the enzyme breaks down and dissolves the tough bands. This lets the fingers straighten when the cord is snapped by the surgeon, usually the next day.
• Needle aponeurotomy. This is another newer, less invasive procedure. Medicine is injected into the area to numb the hand. The surgeon uses a needle to divide the diseased tissue. No incision is made. 

What are the complications of Dupuytren’s contracture?

Over time, you may have trouble using your hand for certain tasks. You may not be able to grasp large objects or straighten your fingers.

When should I call my healthcare provider?

Call your healthcare provider if your symptoms get worse or you have new symptoms.

Key points about Dupuytren’s contracture

• Dupuytren’s contracture is an abnormal thickening of tissues in the palm of the hand.
• The thickened tissues may develop into a hard lump. Over time it can cause 1 or more fingers to curl (contract) or pull in toward the palm.
• You may not be able to use your hand for certain things.
• In many cases, both hands are affected.
• There is no cure, but treatment can improve symptoms.

Dupuytren’s contracture – NHS

Dupuytren’s contracture is when 1 or more fingers bend in towards your palm. There’s no cure, but your fingers can be straightened if it’s severe.

Check if you have Dupuytren’s contracture

Dupuytren’s contracture mainly affects the ring and little fingers. You can have it in both hands at the same time.

It tends to get slowly worse over many months or years. Treatment cannot usually help in the early stages.

It starts with lumps, dimples or ridges on your palm.

Credit:

The Photo Works / Alamy Stock Photo https://www.alamy.com/stock-image-dupuytrens-contracture-deformity-a-cord-in-the-palm-of-hand-with-a-165489889. html?pv=1&stamp=2&imageid=D3ADDB6C-74D5-4573-B28B-52B249349BA1&p=66803&n=0&orientation=0&pn=1&searchtype=0&IsFromSearch=1&srch=foo%3dbar%26st%3d0%26pn%3d1%26ps%3d100%26sortby%3d2%26resultview%3dsortbyPopular%26npgs%3d0%26qt%3dKH6M15%26qt_raw%3dKH6M15%26lic%3d3%26mr%3d0%26pr%3d0%26ot%3d0%26creative%3d%26ag%3d0%26hc%3d0%26pc%3d%26blackwhite%3d%26cutout%3d%26tbar%3d1%26et%3d0x000000000000000000000%26vp%3d0%26loc%3d0%26imgt%3d0%26dtfr%3d%26dtto%3d%26size%3d0xFF%26archive%3d1%26groupid%3d%26pseudoid%3d387440%26a%3d%26cdid%3d%26cdsrt%3d%26name%3d%26qn%3d%26apalib%3d%26apalic%3d%26lightbox%3d%26gname%3d%26gtype%3d%26xstx%3d0%26simid%3d%26saveQry%3d%26editorial%3d1%26nu%3d%26t%3d%26edoptin%3d%26customgeoip%3d%26cap%3d1%26cbstore%3d1%26vd%3d0%26lb%3d%26fi%3d2%26edrf%3d0%26ispremium%3d1%26flip%3d0%26pl%3d

Eventually, your finger may get stuck in a bent position.

Credit:

DR P. MARAZZI/SCIENCE PHOTO LIBRARY https://www. sciencephoto.com/media/711930/view

If you’re not sure it’s Dupuytren’s contracture

Other conditions can have similar symptoms.

Non-urgent advice: See a GP if 1 or more of your fingers are bent and:

• you cannot put your hand down flat
• you’re having difficulty with daily activities

You’ll probably be offered treatment. The GP may refer you to a surgeon to discuss your options.

Information:

You can ask to be referred to a hospital of your choice.

Find and compare hospitals for Dupuytren’s contracture

Treatments for Dupuytren’s contracture

Speak to a specialist about the options, what the benefits and risks are, and what to expect afterwards.

Your finger may not be completely straight after treatment, and might not be as strong and flexible as it used to be.

The contracture could also come back after a few years.

There are 3 main types of treatment.

Surgery to straighten the fingers

Fasciectomy

A cut is made along your palm and finger so the surgeon can straighten it.

• general anaesthetic (you’re asleep) or local anaesthetic (your hand is numbed)
• you can leave hospital the same day
• recovery time: 4 to 12 weeks
• lowest risk of contracture coming back
• risks include bleeding, numbness and infection

Using a needle to straighten the fingers

Needle fasciotomy

A needle is inserted into several places along your palm and finger to loosen and straighten it.

• local anaesthetic (your hand is numbed)
• you can leave hospital the same day
• recovery time: up to 2 weeks
• contracture more likely to come back than with surgery
• risks include a cut opening up in your skin, pain and numbness

Using surgery and a skin graft to straighten the fingers

Dermafasciectomy

Similar to a fasciectomy, except an additional area of skin is removed; a skin graft from elsewhere in the body can be used to replace the removed skin.

• general anaesthetic (you’re asleep) or local anaesthetic (your hand is numbed)
• 2 procedures are needed – 1 to straighten the fingers and then around 4 days later, another procedure to add the skin graft
• contractures less likely to come back than with a standard fasciectomy but recovery times can be longer
• risks include bleeding, numbness and infection

Causes and preventing Dupuytren’s contracture

Dupuytren’s contracture happens when the tissue under the skin near your fingers becomes thicker and less flexible.

The exact cause is unknown, but it’s been linked to:

• having a family history of the condition
• smoking
• drinking lots of alcohol
• having diabetes or epilepsy

It’s not known if you can prevent it or stop it coming back.

Page last reviewed: 15 June 2021
Next review due: 15 June 2024

All about curling – Taimyrsky Dolgano-Nenetsky municipal district

Curling history
Curling equipment
Game rules
Basic terms
Interesting facts

Curling is an ice sports game in which two teams take turns throwing sports equipment (curling stones) towards a target called “home”. A team scores one point for each of its stones located in or touching the target that is closer to the center than any of the opposing team’s stones.

The very word “curling” first began to be used as the name of the game in the 17th century, after the mention in the poem of the Scottish poet Henry Adamson. Researchers believe the game takes its name from the Scottish verb curr, which describes a low growl or roar. The thing is that the granite stone sliding on the ice touched the notches of ice, which caused a characteristic sound. In favor of the correctness of this theory is the fact that even today in some parts of Scotland curling is called “the game of roaring stones”.

Curling competitions are held in the following sports disciplines in accordance with the All-Russian Register of Sports:

1) Curling

2) Curling – mixed

3) Curling – double mixed

In modern Russia, curling as a sport appeared in 1991 in St. Petersburg. The initiators of the development of curling in our country were Konstantin Yurievich Zadvornov and Grigory Dmitrievich Filimonov.

In April 1991, an organizational meeting was held in St. Petersburg, at which a decision was made to start the development of curling in Russia and the first program for the development of the sport in the country was adopted.

The Russian Curling Federation in April 1992 was admitted to the International Curling Federation (International Curling Federation, now the World Curling Federation) and the European Curling Federation.

The President of the Russian Curling Federation is a deputy of the State Duma of the Russian Federation Svishchev Dmitry Aleksandrovich.

The official website of the Russian Curling Federation is www.curling.ru

The World Curling Federation (WCF) by its status is an international sports federation that governs the winter Olympic sport of curling and the winter Paralympic sport of wheelchair curling. The WFC represents the interests of the 53 national curling federations and promotes the development of curling.

The official website of the World Curling Federation is www.worldcurling. org

Curling originated in Scotland at the beginning of the 16th century, the actual confirmation of the existence of this sports game is a curling sports equipment (stone), on the surface of which the date of manufacture (“1511”) is stamped, found at the bottom of a drained pond in Dunblane. The first annalistic references to curling are found in medieval monastic books dated 1541, preserved in the Scottish abbey of Paisley.

The oldest curling club in the world is the association of players from the city of Kilsyth, located in the north of Scotland, founded in 1716. The first curling club was opened in 1737 in the province of Fife. In the same city, there is the oldest man-made sports field designed for playing curling – an artificial dam that encloses a pond and sets a platform measuring 100 by 250 meters.

The first curling association, bringing together many disparate curling clubs, was established in 1838 in Edinburgh. It was named the “Main Curling Club of Caledonia”. The task of the club, among other things, was the unification of the rules of the game, since many clubs at that time still played with stones of different sizes and weights and interpreted the rules in different ways.

In 1843, when Prince Albert became the patron of the association, it was renamed the Royal Caledonian Curling Club. Since 1900, its patrons have been exclusively the kings and queens of Great Britain. The Royal Curling Club served as the World Curling Federation until 1966, where the International Curling Federation began its activities.

In 1991, in anticipation of the inclusion of curling in the list of Olympic disciplines, the International Federation was renamed the World Curling Federation.

From about the 18th century, the shape of the stone began to standardize and take on its modern form: diameter 29.2 cm (11.5 in), height 11.4 cm (4.5 in), weight 19.96 kg (44 lb). The cold climate, abundance of ice and democratic requirements for the game made it very popular in Scotland, and then throughout the world. Together with the settlers who fled to America from the power of the English monarchs, curling also penetrated the New World, and in Canada it became especially widespread due to objective climatic reasons.

In the first half of the 19th century, the rules of the game of curling were officially approved, which have hardly changed since then.

The first demonstration games in curling took place at the Olympic Games in Chamonix in 1924. In addition, demonstration curling competitions were held at the Olympic Games in Lake Placid (1932), Garmisch-Partenkirchen (1936), Innsbruck (1964) and Albertville (1992). But only in 2006. The Olympic Committee revised history and decided to consider demonstration performances as an Olympic event.

The first World Curling Championship for men was held in Falkirk and Edinburgh in 1959 and went down in history under the name of the Scottish Cup Competition, and was won by the Canadian team. The first women’s world championship was held in Perth, Scotland in 1979 and ended with the victory of the Swiss team.

Championships have been held on a regular basis since 1975.

In 1992, the International Olympic Committee (IOC) decided to include curling as an Olympic sport. From 1998 Curling debuted as an Olympic sport at the Nagano Olympics in Japan. The first gold medals were played.

Among men, the team from Switzerland became the first Olympic champions, and among women, the team from Canada.

We find the first mention of curling in Russia in the published materials of the Scottish “Royal Curling Club”, which talk about the creation of branches of this club in 1873 in Moscow and in 1876 in St. Petersburg (for sports entertainment of foreign diplomats and businessmen). In the lists of members of these departments, which apparently existed until the outbreak of the First World War, we find only the names of foreign subjects.

In Russia, curling as a sport began to develop in 1991 in St. Petersburg. In April 1991, the first organizational meeting took place in St. Petersburg, at which the main directions for the development of curling in Russia were determined.

The Russian Curling Federation was established and officially registered in December 1991.

The first section of curling in our country began its activity in St. Petersburg in September 1991 at the Institute. P.F. Lesgaft. The first training sessions took place on the ice of the Yubileiny Sports Palace. In the absence of special equipment at the first training sessions, game enthusiasts performed simulation exercises with models of curling stones made of wood, and hockey sticks were used as a support in the first training sessions. At the end of 19For 91 years, the first real curling training sessions were held with stones and curling brushes.

The first official match of Russian teams was held in October 1991 on the ice of the German city of Hamburg as part of the Hamburg Curling Club Cup. The match was attended by two teams from St. Petersburg.

The first curling tournament in our country with the participation of teams from different regions took place in St. Petersburg in the spring of 1992. As a result, the first national team of Russia was formed.

The first Russian championship was held in the 1992-1993 season. At the final stage of the championship, held in the spring of 1993, the men’s team of St. Petersburg and the women’s team of Vologda won.

The first international curling tournament in Russia was held in the spring of 1993 in St. Petersburg at the rink of the Yubileiny Sports Palace. Amateur club teams from Canada, Finland and Russia took part in the tournament.

The entry of the Russian Curling Federation into international federations – into the International Curling Federation (International Curling Federation, now the World Curling Federation) and the European Curling Federation (European Curling Federation) took place on April 1992 years old

The Russian national team (men and women) was formed in 1992.

At present, distinctive regional “schools” of curling have been formed in Russia and are effectively operating in Moscow and St. Petersburg, in Moscow, Leningrad, Chelyabinsk, Kaliningrad, Sverdlovsk and other regions.

Stone

Game projectile in curling. It has a cylindrical shape and a flat sliding surface. Made from polished granite weighing 19.96 kg (44 lbs), its diameter is 29.2 cm and its height is 11.4 cm.

Brush

A tool for rubbing ice in front of a moving stone in order to change its trajectory. Brushes differ in the stiffness of the material of the rubbing surface, the height of the handle and the angle of the working surface. The player may change the type of brush at any time during the game, as long as it does not cause a delay in the game. The player who has chosen to sweep the broom must use it throughout the match.

Slider

A slider is a slippery sole of one shoe or a special overlay on shoes that makes it easier for a player to slide on the ice during a throw. Anti-slider – an overlay that increases traction with ice, usually worn on the jogging leg

All team members who are on the playing court during the game or warm-up must wear uniform uniforms and appropriate shoes. Coaches/team officials must be in team uniform while in the competition area.

The player’s equipment must be clean and must not leave any marks on the surface of the playing area. The equipment of the player can be examined by the chief referee, both before the start and during the match, and is prohibited for use. Players may use stopwatches but may not use any technical means to negotiate between teammates and the coach.

More information about the rules of the game of curling can be found here.

• The impetus for the development of curling was the ban by the Scottish authorities on classes that distracted people from everyday affairs and led to dissent. Curling was not included in the list of prohibited activities, unlike, for example, golf.
• It is worth noting that the imperfect shape of the shells and the unpreparedness of the field did not allow the ancient curlers to play based on one or another winning strategy, or to develop sportsmanship – in most cases, the outcome of the game was decided by the luck of a particular team or player.
• Interesting information about projectiles is also contained in the annals of the Scottish city of Darvell: weavers rested after work, playing curling with heavy stone weights used in oppression at looms, and these weights had a removable handle. It also says that “many wives supported the authority of their husband by polishing the handle of the stone and bringing its shape to perfection.”
• The lower part of the stone does not have full contact with the ice. The surface of the playing field is touched only by an annular surface, the width of which is 3 cm. This shape of the projectile reduces traction with ice, allowing the stone to slide more easily on the court.
• If a stone breaks during the game, a new stone will be placed on the site in the same place where the largest fragment of the broken stone stopped. Also, the stone can be replaced if, in the process of sliding, it abruptly stops or changes the trajectory of movement (which indicates defects that have arisen on the sliding surface of the projectile).
• If 2 players of the same team are eliminated from the game and it is not possible to replace the eliminated players. Then the match ends, and the team is considered defeated. If a substitution is possible, the match will continue even if only 3 players are left on the field. In this case, athletes under the first and second numbers will perform 3 throws each.
• If the curler releases the stone with his right hand, he must rest with one foot on the block located to the left of the center line of the court, if he uses his left hand, he must push off from the block located on the right. In the event that the athlete pushes off from the opposite block for any reason, the stone draw will be cancelled.

Brushes in hand and on the ice! How a VM correspondent learned to play curling

Plot:

Special report

09 January 2020 21:18 Sports

VM correspondent Daria Piotrovskaya tries her hand at curling. She makes the first attempt to send a granite projectile at the target, while the representative of the opposing team, Maria Blokova (left), is waiting for her turn / Photo: Anton Gerdo / Vechernyaya Moskva

Curling master classes have started in Moscow parks, and they are taught by the best Russian athletes. The Vechernaya Moskva correspondent went to learn how to play roaring stones at the Jazz Skating Rink in the Hermitage Garden.

Exciting cries and laughter do not stop in the center of the ice rink. Two girls in bright down jackets play against a chubby boy and a tall man. Here, holding a 20-kilogram projectile by the handle, the athlete accelerates and, almost flattened on the ice, sends a stone to the target (it is called “home”) at the end of the field. Beautiful! Soon the player leaves. I take his place next to ten-year-old George. Coach – Alexei Kamnev, master of sports of international class, repeats the rules, and we start.

Curling is a team game, no one is a warrior on the ice. I’m getting ready to throw the first projectile, my partner is waiting at the target with a brush. He will “sweep” – rub the ice in front of the stone so that it will definitely fly! We got blue shells, our opponents got yellow shells.

— I believe in you, Daria! George screams.

I can’t let him down! I put my foot on the stand, push off … The first attempts are no good. It is unbearable to watch how easily the stones of the opponents roll straight to the center! It’s hot, down with the down jacket! Trying to throw a projectile better, I run up from the starting position, scratching my legs on the ice … It doesn’t matter! The main thing is victory! But how difficult it is to calculate the impact. My throws are too strong – the stones always fly farther than the target. We change places with George, now I work the ice, and he throws stones. I tensely follow his movements, squeezing the “mop”.

The coach tells you when to ice and when to stop.

“Great throw,” he praises my partner.

Curling is called a gentleman’s sport: in this game it is better to lose than to act meanly. But something like is possible: to rub the ice in front of the opponent’s stone so that he flies past the “house”! This becomes my strategy.

— Don’t rub other people’s stones! – Masha, a girl in a pink down jacket, screams loudly.

What is it about? Is it impossible or does she just not like the way the shells fly out over the fence?

“It is possible, but only in the far half of the “home,” the coach resolves the contradiction. I accidentally move the yellow stone to the center!

— Thank you, — the rival taunts.

Sports may be gentlemen’s, but the competition is real! Emotions are hard to contain. We, the Blues, barely have time to discuss the strategy, changing roles on the field, shouting with might and main.

Having sent another projectile to slide towards the target, I think: why is curling called chess on ice? Everything is much more dynamic here! The sky and the earth seemed to have disappeared, only the ice remained – it will determine which of us is stronger.

But now all 16 shells are launched. Time to collect stones! We won one out of four games. It’s a shame, but it was great. The players are flushed and happy.

— Are you sure you haven’t played before? – I ask the “yellows”. Why did they win against us?

“Yes, for the first time,” Maria laughs. We just started an hour early!

Kamnev carries shells off the field. This is where serious physical preparation is needed! And for the game, it can be anything – that’s what makes curling unique. Of course, if you are interested in elite sports, you need to train seriously.

“The longer you play, the more you open up,” says the coach. – The main thing is logic, the ability to make decisions quickly. And there is such a variety of strategies that books are written about them. In curling you need to think. It is not enough to get to the center of the house, you need to save the stone. After each throw, the situation changes, and playing carelessly is not an option. The skill of the players and their composure are important.

RULES OF THE GAME

The curling field is rectangular, about 45 meters long. Main props: 16 granite projectiles and brushes for rubbing ice in front of a sliding stone.