Dupuytren's contracture is an abnormal thickening and tightening of the normally elastic tissue beneath the skin of the palm and fingers. This tissue is called fascia. The fascia contains strands of fibers, like cords, that run from the palm upward into the fingers. In Dupuytren's contracture, these cords tighten, or contract, causing the fingers to curl forward. In severe cases, it can lead to crippling hand deformities.
What Causes Dupuytren's Contracture?
The cause of Dupuytren's contracture, also called Dupuytren's disease, is unknown, but certain biochemical factors that affect the palm's connective tissue may be involved. Injuries and overuse of the hand do not play a role. Tendons are not affected.
However, certain things may make you more likely to develop Dupuytren's contracture. They include:
- Drinking a lot of alcohol, although most people with the disease do not have alcoholism
- Seizures, such as those seen in people with epilepsy
The condition usually runs in families, which means it is inherited. You are also more likely to develop this condition if you have a Northern European (English, Irish, Scottish, French, Dutch) or Scandinavian (Swedish, Norwegian, Finnish) background.
Dupuytren's contracture is more common in men than women, particularly those over age 40.Your chances of developing it increase as you get older.
Symptoms of Dupuytren's Contracture
The first symptom for many patients is one or more lumps (nodules) under the skin in the palm of the hand. The lump may feel tender and sore at first, but this discomfort eventually goes away.
The nodules cause tough bands of tissue to form under the skin in the palm. These inflexible bands cause the fingers to bend, or "curl," forward toward the wrist. As this curling gets worse, it becomes difficult, if not impossible, to straighten the fingers.
The pinkie and ring fingers are most often affected, appearing clenched. Both hands are usually involved, although one may have worse symptoms than the other.
People with Dupuytren's contracture often have a hard time picking up large objects, or placing their hands into their pockets, something you might do on an everyday basis to retrieve coins, cash, or your ID card. If you have this condition, you may also find it difficult to place your hand flat on the table, wear gloves, or shake hands, among other things.
Diagnosing Dupuytren's Contracture
Your health care provider will examine your hands, wrists, and fingers. Diagnosis of Dupuytren's contracture typically involves feeling the palm areas to check for nodules and recording how many nodules are found. Your doctor will likely ask you to try to place your hands flat on a table.
Tests may also be done to:
- See how well you can grasp items with your hands.
- See how well you can pinch items with your fingers.
- Measure the feeling in your thumbs and fingers.
- Determine your range of motion in your fingers, to see if you can straighten them all the way.
These exams and tests will be repeated over time to determine if the condition is getting worse.
How Is Dupuytren's Contracture Treated?
There is no cure for Dupuytren's contracture. However, the condition is not life-threatening, and it may not cause a person discomfort for many years, if ever. Some patients never need treatment, just monitoring.
If the condition is painful or interferes with a person's daily activities, treatment may be helpful. Treatment includes medication and surgery.
It's important to note that finger splints do not help patients with Dupuytren's contracture and may even be harmful. Stretching the finger forcefully can actually speed up the inward curling of the finger.
Medication for Dupuytren's Contracture
If a nodule is extremely tender, your doctor may recommend a corticosteroid injection, also called a steroid shot. A corticosteroid is a powerful anti-inflammatory medicine, which reduces swelling and inflammation. It may help ease your pain and in some cases may prevent finger contractures from getting worse, but won't straighten your finger if you already have a contracture. You might need a series of shots to see long-term results.
If your fingers are already bent,collagenase (Xiaflex), a mixture of enzymes that help dissolve the thick and tight tissue, may be injected into the affected area by your doctor. This weakens the tight bands and may allow your doctor to then stretch the tightened area. The most common side effects seen with Xiaflex are swelling, bleeding, bruising, or pain at the injection site. Rarely, tendon or ligament damage may occur that requires surgery to fix. Your doctor can help you determine if enzyme injections or surgery is right for you.
Surgery for Dupuytren's Contracture
If the condition continues to get worse despite medications and your hand function is severely limited, your doctor may recommend surgery.
Traditional surgery for Dupuytren's contracture involves cutting or removing the thick bands of tissue in the palm of the hand to help restore proper finger motion.
All surgery comes with risks. Complications of Dupuytren's contracture surgery are rare but may include:
- Injury to the nerves and blood vessels in the hand
- Permanent stiffness of the fingers
You will have some hand swelling and discomfort after the procedure. Raising your hand above your heart level and flexing your fingers can help relieve swelling, stiffness, and pain and speed up your recovery. Recovery can take several months.
Most patients can move their fingers better after traditional Dupuytren's contracture surgery. However, the condition returns in about one in five people who have had this surgery.
A less invasive procedure, called needle aponeurotomy, is an alternative to traditional surgery for Dupuytren's contracture. Instead of an open incision, it uses the sharp end of a needle to cut the thick bands under the skin, which may help you recover faster. However, it is not as effective in treating the more severe cases. As a whole there is less risk of complications, but there is a risk of nerve, blood vessel, or tendon damage. Needle aponeurotomy is even more effective when used in combination with corticosteroid injections. A specialized hand surgeon must perform this procedure. Ask your doctor what type of surgery is best for you.
Your doctor may recommend physical therapy after surgery.
When to See a Doctor
Dupuytren's contracture is not a dangerous condition, but it can be disabling if it becomes severe.
Call your doctor for an appointment if:
- You have one or more lumps in your palm, whether or not it is painful.
- You have difficulty straightening your fingers.
- You have difficulty grasping objects.
- You cannot place your hand flat on a table or place your hand in your pocket.