Dupuytren's contracture can cause slow but progressive changes in the palms of the hand.
With Dupuytren's, scar tissue develops underneath the skin of the palm. As the disease progresses, the scar tissue shrinks. This slowly pulls the fingers into in a bent position called a contracture. Over time, Dupuytren’s curtails daily activities.
"The ring and the small finger are more affected than the other fingers," says Charles Eaton, MD, a hand surgeon who has treated many patients with Dupuytren's and is founder of the Dupuytren Foundation in Jupiter, Fla. People can often get by in early stages. That's because slight bending works fine for many daily activities, he says. In fact, many people at these early stages may not even know there's a problem, or they might confuse it with something else.
Early Stages of Dupuytren's
In most cases, Dupuytren's first appears after the age of 40. The first sign at this stage is a lump in the palm of the hand.
"Many people mistake it for a callus," says Eaton. "They think they've done something with their tennis or golf grip. Or they just believe they have a callus and don't think anything of it because it doesn't bother them at all."
Symptoms During Early Stages
In addition to a lump, some Dupuytren's patients will have burning, itching, or temporary tenderness in the area as well. "Patients describe the tenderness as similar to a bruise that is resolving or a cut that is in the last stages of healing. It can also be mistaken for tendonitis but it affects a layer of tissue directly under the skin and tendons are not directly involved."
At this stage, the hard lumps in the palm are called nodules. They may go away on their own in a small number of patients, but they usually progress. They can stay for months or years before anything else happens, says Eaton.
Although many types of treatment have been tried for early stages, few have shown a benefit. "A long-lasting cortisone injection into the nodules [may] have the ability to turn the disease process off, at least temporarily," Eaton says. This may delay Dupuytren's contracture progression. In some cases, a series of injections is needed for best results.
When Dupuytren's Progresses: Symptoms During Later Stages
Dupuytren’s tends to progress more rapidly in men than in women and in those who have both hands involved. As Dupuytren's progresses, the nodules thicken into cords that feel like strings beneath the skin. The skin begins to shrink in the area that once felt lumpy. What happens is similar to what happens when the body heals open wounds, says Eaton. The wound triggers a scarring and shrinking process, and the body gradually pulls the edges of the skin together so that the wound is closed.
With Dupuytren's contracture, this process is activated inappropriately, says Eaton. "If you biopsy tissue that’s active with Dupuytren's, you'll find that the biology is very much like what you'll see with an open cut."
When do symptoms become a problem? People begin to notice changes, says Eaton, if the shrinkage causes contraction that is enough to limit the motion of a finger. Most people notice tightness in their fingers when they can't straighten them all the way. As the condition progresses, it can interfere with the use of the hand.
How Life Is Affected by Dupuytren's Contracture Progression
The greater the degree of contracture, the greater Dupuytren’s will affect your daily activities. Those who do activities where the palm needs to be stretched flat may notice the tightness of Dupuytren's progression earlier than others, says Eaton. Musicians who play keyboard or reed instruments need to spread their fingers, so they may notice the changes early on.
"Just imagine your ring finger bending and not being able to straighten," says Eaton. After a point, you will have trouble doing very specific activities, such as getting your hand into your pocket if you're wearing tight jeans or reaching into a narrow space to put a seat belt into the slot.
As the finger bends farther and gets closer to 70-80 degrees, applying shaving cream or scrubbing the scalp with shampoo also becomes tough because flattening the palm isn't possible.
As the bend gets closer to 90 degrees or more, you may have trouble putting on gloves or washing your face.
With fingers pointing down at 135 degrees or more of bend, hygiene can become a problem because the folds of skin become difficult to dry. As a result, they may develop foul-smelling fungal infections similar to athlete's foot.
Treatment for Progressive Dupuytren's Contracture
Surgical treatment can be effective when Dupuytren's progresses. But is only recommended when the contracture is severe and causes significant activity limitations. That's because surgery to divide or remove the thickened bands carries risks, says Eaton. And recovery can take two or three months. Some of the complications of traditional open surgery include slow healing, nerve injury, and permanent stiffness.
"Before surgery, someone may not be able to straighten a finger," says Eaton. "Then after the dust settles, they may not be able to bend the finger all the way."
The disease can come back, so surgery is not a cure. Over time, many have a recurrence, says Eaton. The younger you are when you first develop Dupuytren's, the more likely you will need surgery, and the greater your chance for recurrence.
Needle Release and Enzyme Procedures
Other less invasive techniques may be useful for Dupuytren's contracture. These procedures include the use of small incisions, needle release, and enzyme injections. According to Eaton, "they don't make big wounds in the skin, so they don't set off the biology of Dupuytren's." Recovery is quick and complications are less frequent. These procedures, however, are only recommended for certain patients with Dupuytren’s.
In the end, even though treatment may help reduce the stiffness and deformity at various stages of Dupuytren’s disease, there is still no cure for this disease.