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Dupuytren's Contracture

Dupuytren’s contracture can interfere with a person’s daily activities and one of the most common conditions that hand surgeons treat.

A woman holding her hand in discomfort.

What is Dupuytren’s contracture?

Dupuytren’s contracture, also known as Dupuytren’s disease, is a genetic disease that affects the hands, causing the fingers to close in, leaving a person unable to straighten them. In this condition, a layer of connective tissue underneath the palm of the hand called fascia becomes thickened from an overgrowth of collagen. This causes the tissue to tighten, forcing the fingers to flex in. The condition progresses slowly and usually without pain, but it can prevent a person from performing some tasks or skills.

Dupuytren's should not be confused with trigger finger, a separate condition which also causes fingers to flex uncontrollably.

What causes Dupuytren’s contracture?

Although the precise cause of Dupuytren’s is unknown, those with a family history are at greater risk, although not everyone whose parent had the disease will develop it.

What are the risk factors for Dupuytren’s contracture?

Men develop Dupuytren’s more often than do women, and most people develop symptoms after age 50. People with diabetes, are of Northern European descent, or who use alcohol or tobacco have a higher risk of getting Dupuytren’s. There is no indication that it comes from performing specific jobs or activities. However, in individuals with a genetic predisposition, a hand injury or even hand surgery may trigger the condition.

What are the symptoms of Dupuytren’s contracture?

The earliest sign is a skin nodule in the palm that can be mistaken for a callus. It may enlarge and become painful, causing some people to worry that they have some kind of tumor. However, the nodule caused by Dupuytren’s disease is always benign. Cancerous growths in the palm of the hand are exceedingly rare.

Mild versus aggressive forms of Dupuytren’s

Many cases of Dupuytren’s disease are mild, and the condition may progress very slowly. The small nodule will remain the same for years or even decades, not causing any problems, and many people will never need treatment. In general, Dupuytren’s is not painful unless aggravated by forceful activities that put pressure on the nodule.

The aggressive form of the disease can be debilitating, limiting the ability to perform everyday activities. In severe cases, bands of tissue underneath the skin develop into thick cords that contract the fingers, causing them to curl toward the palm. It most often affects the ring finger and the pinkie, but can affect all fingers, including the thumb. Over time, as the disease progresses, secondary contractures develop in the ligaments and tendons of the fingers, making the condition at least partly irreversible.

In its most severe form, known as “Dupuytren’s diathesis,” the disease affects patients at an early age, involves both hands, most digits, progresses more rapidly and is more likely to recur following treatment.

The physician usually makes the diagnosis based on the appearance of a patient’s hands and fingers and the range of movement. An MRI or other imaging studies are generally not needed.

When should I see a doctor if I think I have Dupuytren’s?

When seeking a diagnosis or treatment, it’s better to see a doctor sooner rather than later. Once a contracture is severe, Dupuytren’s disease is more difficult to correct.

Dupuytren’s contracture treatment

There is no cure for Dupuytren’s, but there are effective treatments. Many patients have the full function of their hand restored. Nonsurgical treatments include corticosteroid injections or Xiaflex, a prescription drug that breaks down collagen. Surgical removal of excess tissue is necessary in some patients.

Nonsurgical treatment for Dupuytren’s

For patients with an early manifestation of the disease, such as a small lump in their palm but no noticeable symptoms, the best course of action is to be evaluated by a hand specialist, who can make an accurate diagnosis and record a baseline examination. Patients are generally advised to do nothing about the condition other than return to their physician every three to six months to see if the disease has progressed. Many will not develop symptoms for years, if at all.

However, if the disease progresses and starts interfering with hand function, different treatment options are available to slow the progression and improve motion in the affected fingers.

For some patients who are experiencing a painful nodule, a series of three cortisone injections may provide relief and slow the progression of a contracture. The effectiveness of a steroid injection varies among patients.

Another treatment entails the injection of an enzyme known as collagenase into the hand to break up the cord and enable the individual to regain movement in the affected fingers. This treatment is very effective, especially in the earlier stages of the disease. However, about 30 percent of patients may see a recurrence of Dupuytren’s within three years.

Surgical treatment for Dupuytren’s

For those with progressive contractures, surgery is often the best course of action to restore hand function. Contracted fingers may make daily activities difficult or impossible, including reaching into a pocket, shaking hands, putting on gloves, or even washing one’s face. Using a keyboard is particularly troublesome, both because of the inability to straighten the involved digit and the impaired reach of the small finger. Pianists find the “extra octave” increasingly difficult as the span of their hand narrows progressively.

What is the surgery for Dupuytren’s Contracture?

The surgery entails removing excess tissue in the palm of the hand. It is an intricate outpatient procedure that should be performed by an experienced hand surgeon under magnification, as care must be taken to protect the nearby blood vessels,

How do you know if you need Dupuytren’s surgery?

At HSS, we have strict criteria for recommending surgery for Dupuytren’s contracture. We do not recommend it for patients with early disease that is not interfering with their lives. We do advise patients to have their hand checked periodically, and we recommend a simple “table-top test” that can be done at home to help recognize progression. This is performed by simply placing one’s hand down flat on a surface – if one or more fingers can no longer lie flat on the table, it is time to visit the hand specialist.

Surgery is reserved for those with Dupuytren’s who are experiencing symptoms that impede hand function. The goal is to restore motion in their fingers so they can regain normal use of their hand.

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