American Medical Association Family Medical Guide - American Medical Association [689]
Dupuytren’s Contracture
In Dupuytren’s contracture, also called palmar fasciitis, a layer of tough, fibrous, connective tissue that lies directly under the skin on the palm of the hand thickens and shrinks over time. This shrinkage eventually causes fingers, most often the ring finger and little finger, to permanently fold in toward the palm at the knuckles. One or both hands and sometimes the bottom of the foot may be affected. The cause of Dupuytren’s contracture is unknown.
Dupuytren’s contracture
In Dupuytren’s contracture, the fingers of one or both hands are fixed in a bent position. The ring finger and little finger are the most frequently affected.
Symptoms and Diagnosis
Although Dupuytren’s contracture is not usually painful, it stiffens the fingers in a flexed position and weakens the grasp. You may also have thickened skin pads over your other knuckles and on the balls of your feet. See your doctor right away if you have any of these symptoms. A doctor can diagnose Dupuytren’s contracture by its appearance.
Treatment
If Dupuytren’s contracture is treated early enough, the stiff fingers can be unbent surgically in a procedure that either removes or cuts through the thickened tissue. With physical therapy, you can regain the use of your hand. If untreated, the condition can become permanent. In some cases, the contracture recurs after treatment.
Muscle Tumors
Tumors in muscles are rare and are usually not cancerous. It is not known why muscle tissue seems to resist tumors. When cancerous tumors do develop in muscles, however, they are difficult to treat, and tend to grow and spread quickly.
Symptoms and Diagnosis
Usually the only sign of a growth in a muscle is pain or a detectable lump. In some cases, the tumor may grow moderately over a long period. If the growth is cancerous, it enlarges rapidly and may become more painful. A large muscle tumor can interfere with muscle contraction. See your doctor without delay if you develop an unexplained lump anywhere on your body.
The doctor will examine you and may recommend X-rays, a CT scan (see page 112), or an MRI (see page 113) of the affected area. He or she may also recommend a biopsy (in which tissue samples are taken from the lump and examined under a microscope).
Treatment
If you have a noncancerous tumor, your doctor will want to check it periodically for any changes. If you have a cancerous tumor, possible treatments include surgery, chemotherapy (see page 23), or radiation therapy (see page 23), or a combination of these, depending on the type of tumor and its location and size.
Bone Disorders
Bone is living, constantly changing, tissue that consists of several different types of cells embedded in a framework of collagen (a protein that provides structure and strength). The soft parts of bone that contain dense deposits of calcium salts make bone different from other connective tissue and give bone its strength.
Most bones develop from continuously growing pieces of cartilage that gradually harden. Some bones, such as the skull and the collarbone, form in membranes that develop in the skin of embryos. Inside some bones are spaces occupied by marrow, a tissue that contains the cells that form all the different types of blood cells in the body.
Fractures
A fractured, or broken, bone occurs when a bone is stressed by a force greater than it can withstand. Bones that are weakened by a bone disease such as osteoporosis (see page 989) or bone cancer (see page 995) are especially vulnerable to fracture. The bones most likely to break are those in the wrists, hands, and feet. Fractures of other bones (such as the arm bones, leg bones, spine, and hip) are usually the result of a powerful force such as a vehicle collision.
The older you are, the more likely you are to break a bone. Children have resilient bones that tend to bend rather than snap. The bones of older people fracture more easily as they lose calcium