Looking to the future: Trends in Disease - Dupuytren’s Contracture
Dupuytren’s Contracture (‘DC’) is a condition which affects the hands and fingers. Symptoms normally include one or more fingers or thumbs bending into the palm of one or both hands. Problems occur when the connective tissue in the palm thickens into a small hard nodule under the palm of the skin with further nodules developing as time passes. When the nodules extend and form cords these contract and pull the fingers and/or thumbs towards the palm of the hand affected. The nodules which form are not life threatening but the condition is difficult to live with and normally the contractures get increasingly worse over time.
The exact cause of DC is not known although symptoms have been linked to age, family history, smoking, diabetes and medication used to treat epilepsy. Ancestry is also thought to be linked to DC, with patients of Northern European descent having an increased risk of the condition. Treatments for the condition include radiation therapy, collagenese injections and in severe cases surgery to shorten or remove the connective tissue to relieve tension.
There is no evidence to suggest work involving exposure to vibration causes DC. That said, recent research by the Oxford Musultoskeletal Biomedical Research Unit considered the issue of Hand-Transmitted Vibration (HTV) and also the relationship between DC and occupational exposure to HTV.
Their research, which included a survey of 4,969 male respondents, concluded that the risk of DC more than doubled in men with high levels of exposure to HTV. In 2015 the Health & Safety Laboratory prepared a detailed paper for the Health & Safety Executive which discussed a possible link between DC and vibration. Whilst the paper ultimately concludes there is no convincing evidence vibration exposure on its own is causal to DC, it does highlight DC remains a highly topical issue which is under observation by Government bodies.
Recognition as an Industrial Disease
The Industrial Injuries Advisory Council (IIAC) is an independent statutory body set up in 1946 to advise the Government on whether a list of prescribed diseases for which benefits are paid should be enlarged or amended.
In May 2014 the IIAC undertook a review of upper limb disorders and came to the conclusion there was sufficient evidence to add DC to the list of prescribed diseases for which Industrial Disablement Benefit is paid where:
- The claimant has worked for 10 years or more with hand held power tools
- Use amounts to at least two hours per day for three or more days per week
- Symptoms commence after first exposure to the tools
- Flexion deformity is present in one or more digits.
Following this review there has been notable interest in DC from both trade unions and claimant solicitors who are investigating links between DC and potential compensation claims.
This exposure in the media has sparked interest from claimant firms wishing to capitalise on potential new areas for occupational disease claims. Insurers and companies involved in forestry, construction, foundry, steel, factory assembly and estate management work should be alert to this growing issue.
Employers are reminded of their duty to safeguard their workforce from potential hazards involving the development and aggravation of upper limb disorders. They should also provide adequate training, where appropriate, as failure to do so may lead to claims for compensation.