Incidence and Prevalence of Dupuytren’s Contracture in the United States Correlated to a Local Orthopedic Clinic
by Angela Frady, MS, ATC, OTC, NCT
Dupuytren’s contracture is a disease that results in thickening and shortening of the palmar fascia. It usually affects the ring and small fingers at the metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints.2 Although the condition is usually painless, it can become disabling, causing the loss of the use of one or more of the fingers. The thickening does not allow for full extension of the fingers/thumb. It is considered a rare condition in the United States because less than 200,000 cases have been reported.1 There are several studies published that establish the incidence and prevalence of the disease throughout the world. The epidemiology of the disease is theorized to include genetics and a correlation with other diseases, however there is no research to support this.
Modern researchers theorize Dupuytren’s contracture was passed down from the Vikings as they invaded Northern Europe. The disease is nick named the “Viking hand” due to its history. The incidence of the disease correlates with this theory as it affects mostly white males of Northern European ancestry. The disease affects 80% of males with Northern European ancestry throughout the world, usually in the fifth or sixth decade of life.2 Dupuytren’s contracture does affect females, however, the condition presents a decade later in women and is slower progressing and less severe.
A study conducted by Brouet in 1986 attempted to link the history associated with Dupuytren’s contracture disease with its theoretical origin. He noted a difference in the prevalence of Dupuytren’s contracture in French Mediterranean’s with blue-eyes versus brown-eyes. This increase is thought to be the result of the Viking invasion of the Mediterranean coast and Sicily in 1066. Due to this invasion, there are blue-eyed individuals in Toulon, Italy. There is a 40% increase in individuals with blue-eyes in this area of Italy compared to their brown-eyed counterparts. This trait of blue-eyes is thought to have come from the invasion by the Vikings. With this increase there is also a 17% increase of Dupuytren’s contracture in the blue-eyed individuals versus the brown-eyed individuals in this area of Italy. This offers support to the inheritance theory of this disease. However, in Brittany and Normandy the percentages are lower even though these countries were also invaded.9
Worldwide the incidence and prevalence of Dupuytren’s contracture varies. In Norwegian populations, 30% of all males over the age of 60 have Dupuytren’s contracture. A study performed in 2004, shows 34.4 per 100,000 men age 40-84 years in Great Britain have Dupuytren’s contracture. Australia shows approximately 28% of the population is affected by the condition. Spain shows 19% of all men over the age of 60 are diagnosed with Dupuytren’s.2
The disease does affect other races; however, the incidence is less common. As an example in the Asian population, the prevalence of the disease is 3%. The disease involves the palm and not the digits; although no study suggests why the disease affects this population differently.2 The disease is sporadic in Africa.2
A study performed in Norway, examined a random sample of 2,165 males and females ages 46-74 years. This study examined the hands of these individuals and noted 19.2% of males and 4.4% of females showed clinical signs of the disease. They also noticed an increase of the incidence with age. Male’s aged 45-49 reported the condition at 7.2% compared to 39.5% of males aged 70-74 years.6
The underlying etiology of this disease is unknown, but it is thought genetic factors play a role.2 In the US, studies have shown 4% of all Americans with Northern European ancestry have Dupuytren’s contracture of some severity. 2 A study published in 2010 looked at the prevalence and incidence of Dupuytren’s contracture in the United States. This was a population-based study in which they surveyed 40,000 individuals. 23,103 people responded to the survey. 400 individuals responded with either a self-reported case or a diagnosis of Dupuytren’s contracture. A second survey was sent to these individuals where 326 responded, of those 165 had been diagnosed with Dupuytren’s contracture. 104 or 63% were males and 61 or 37% were females. Ages 45-59 had the highest prevalence in all the age groups. 80% of the diagnosed cases were white, 6% black, 4% Hispanic and 5% bi-racial as self-reported by the patients. 18% reported immediate family members with symptoms, while only 3% of family members were diagnosed with the condition.3
A study performed in 1944 showed a prevalence of Dupuytren’s contracture between 1-2% in the United States.9 Studies performed several decades’ later show an increase in the incidence to 4-6% in the United States.10 A study in 2012 in New York City looked at 5,000 people who were admitted to the hospital on an unrelated condition. Upon examining their hands, 4.8% of males showed some sign of the condition.7 The increase is believed to be the results of the influx of population in the United States throughout the years. The disease continues to affect mostly white males.9
While studies show a large prevalence of Dupuytren’s contracture in white males, they also show an increase in the disease with an increase in age. Several studies have shown the disease to be extremely rare in early childhood. A study performed in 1954, showed an increase of prevalence of Dupuytren’s contracture increases on average by 8.72-13.64% with each decade of life. The incidence of Dupuytren’s contracture presents more heavily during the fifth and sixth decade of life.9
There is little evidence of Dupuytren’s contracture being correlated with other conditions such as diabetes, smoking or alcoholism. Studies have shown no clear relationship established between these or any other diseases. Loos and colleagues looked at 2,919 hands diagnosed with Dupuytren’s to determine a relationship between the disease and diabetes, smoking or alcoholism. Their research showed no statistically significant evidence linking Dupuytren’s or any other disease.8
There are several other attempts to correlate who or where Dupuytren’s is diagnosed most commonly. There is no known reason why males are affected more than females. It does not appear Dupuytren’s is more commonly prevalent in the dominant hand when compared to the non-dominant hand. In 1983, a study performed by Goyrand showed the first correlation between the disease and a family link. Further this study showed a positive family history of Dupuytren’s more commonly associated with the female genealogy then with males. In 1990, Flint noted there seems to be no single pathological factor but rather numerous exacerbating factors contributing to the disease.9 Some hand surgeons believe a traumatic event to the hand or distal forearm may precipitate onset of the disease. There have been numerous population-based studies to examine this but they have failed to show a correlation.8
There are several treatments available for this condition, which include (but not limited to) fasciotomy, enzyme injection and/or needle aponeurotomy procedure. The needle aponeurotomy procedure is not a common procedure and few doctors are proficient at this technique. Based on an Internet search, there are three physicians, in Texas, who perform the needle aponeurotomy procedure, which will help to keep these patients out of the operating room.5 One physician, who performs the needle aponeurotomy procedure, practices in the Dallas/Fort Worth metroplex. A review of the electronic medical record (EMR) of his clinic is used to compare demographic data in his practice to the information provided in literature for patients with Dupuytren’s contracture
The Dallas/Fort Worth metroplex has a very ethnically, diverse population of 6.3 million people.4 In an attempt to correlate the data, found in current research with that of a local physician who diagnosis and treats Dupuytren’s contracture, an examination of the EMR of that clinic was performed. In the Dallas/Fort Worth metroplex, Dr. Nilpesh Patel is one of the physicians treating this condition with the needle aponeurotomy procedure. In clinic, several cases of Dupuytren’s contracture are diagnosed monthly causing the condition to appear more prevalent then described in literature. A search of the EMR database provided some demographics of the patients diagnosed. Of note, these patients are not limited to the metroplex, as patient’s nationwide seek out Dr. Patel for diagnosis and treatment of their Dupuytren’s contracture with the needle aponeurotomy procedure.
A search of the EMR database for patients with a diagnosis of Dupuytren’s contracture (728.6 until 9/30/2015 or M72.0 10/1/2015-present) showed 76 patients over a three-year time period (January 1, 2013 to January 1, 2016). Of those patients 78.9% (60) were male and 21.1% (16) were female (Table 1). 91% (69) white, 0.06% (5) Hispanic and 0.01% (1) Asian as reported by the patient on their demographic sheet. One patient failed to report on their race (Table 2). The largest age group was 71-80 years of age at time of diagnosis with 24 patients. 22 patients were 61-70 years of age at time of diagnosis. 24 patients were 60 or younger at the age of diagnosis and 6 were 81 or older at age of diagnosis (Table 3). This research shows almost 4:1 men to women in the clinic diagnosed with Dupuytren’s contracture in a three-year time span, which correlates with the current research.
As the population continues to diversify, it is presumed the incidence and prevalence will decrease through the Caucasian population and increase throughout the others. The search through the clinic database with demographics and diagnosis codes showed a correlation similar to that found in the current research. The correlation is consistent with gender and race as identified by the patients. The search of the database also showed an increase in the diagnosis of the condition with an increase in age.
Dupuytren’s contracture is a condition that affects more males than females and more Caucasians over any other race. The condition has several treatments to negate the disabling aspect of the condition; however, it will not rid the patient of the condition. The link to why an individual is affected by the disease is still unknown. The data gathered from the clinic database correlates with the gender, race and age of that of the current research.
About the Author:
Angie Frady is a clinical coordinator for Lakewood Orthopedics and Sports Medicine in Dallas, TX. Angie is originally from Pfafftown, NC. She received her Bachelor’s degree in Sports Medicine at Methodist University in Fayetteville, NC. She then went on to obtain a Master’s degree in Health and Physical Education at NC A&T State University in Greensboro, NC. After teaching and athletic training for a middle school in Mount Pleasant, NC, Angie spent one year at the University of Iowa obtaining an add-on certificate to become a physician extender for orthopedics. She has completed two rotations as an athletic trainer volunteer at the United States Olympic Training Center in Colorado Springs, CO. Angie lives with her husband in Forney, TX.