other
joints of the body.

[Illustration: FIG. 172.--Congenital Contraction of Ring and Little
Fingers.]

The affection is usually disregarded in infancy and childhood as being
of no importance. In young children, the deformity is corrected by
wearing a light splint fixed with strips of plaster, or a piece of
whalebone or steel inside the finger of a glove. In older children,
the finger may be straightened by subcutaneous division of the
ligament over the palmar aspect of the base of the middle phalanx, or
failing this by lengthening the flexor tendons and resecting a wedge
from the dorsal aspect of the first phalanx close to the
inter-phalangeal joint.

#Dupuytren's Contraction.#--This is an acquired deformity resulting
from contraction of the palmar fascia and its digital prolongations
(Fig. 173). It is rare in childhood and youth, but is common after
middle life, especially in men. It is often hereditary, and is said to
occur in those who are liable to gout and to arthritis deformans.
While it is met with in the working-classes and attributed to the
pressure of some hard object on the palm of the hand--such as a hammer
or shovel or whip--its greater frequency in those who do no manual
work, and the fact that it is very often bilateral, indicate that the
constitutional factor is the more important in its causation.

[Illustration: FIG. 173.--Dupuytren's Contraction.]

In the initial stage there is a localised induration in the palm
opposite the metacarpo-phalangeal joint, and the skin over it is
puckered and closely adherent to the underlying fascia. After a
variable interval, the finger is gradually and progressively flexed at
the metacarpo-phalangeal joint. The ring finger is usually the first
to be affected, less often the fifth, although both are commonly
involved. It is rarest of all in the index. The flexion may be
confined to the metacarpo-phalangeal joint, or the middle and distal
phalanges may also be flexed; and as the deformity becomes more
pronounced, the nail of the affected finger may come into contact with
the skin of the palm. Dissections show that the flexion of the finger
is the result of a chronic interstitial overgrowth or fibrositis and
subsequent contraction of the palmar fascia and of its prolongations
on to the sides of the fingers. The digital processes of the fascia
are thickened and shortened, and come to stand out like the string of
a bow. The adipose tissue in the skin of the palm