Dupuytren’s Contracture

Dupuytren’s contracture is a condition characterized by the thickening of the underlying fibrous tissues of the palm, causing the fingers to bend inward. Patients with this condition are unable to fully straighten the affected fingers. It commonly occurs in the ring finger and little finger. Occasionally, the middle finger is affected, but the thumb and index finger are rarely affected.

Causes and risk factors

Dupuytren’s contracture is caused by the excessive production and deposition of collagen under the skin. The cause for this is unknown. However, there are certain risk factors that may increase your chance of developing the condition. These may include:

• Age: More frequent around age 40
• Social habits: Smoking and alcoholism 
• Medical conditions: Diabetes, cirrhosis of the liver and seizure disorders 
• Gender: More common in males than females
• Heredity: Runs in the family
• Ancestry: Northern Europeans and people of Scandinavian descent

Symptoms

The most commonly observed symptoms of Dupuytren’s contracture are lumps or nodules in the palm of the hand, difficulty in straightening the fingers and contracture of the nodules, which form tough bands under the skin. It usually progresses slowly over many years and is not painful. However, some cases may progress rapidly and cause pain.

Diagnosis

Dupuytren’s contracture is diagnosed based on your history and physical examination. The physical examination may involve pressing on different parts of your hands and fingers to identify hardened knots or tough bands of tissue. It does not require any special tests.

Treatment

You may not need treatment for Dupuytren’s contracture if the condition does not affect your ability to perform daily activities. However, if you are experiencing pain or are having difficulty using your hands for everyday activities, your doctor will recommend conservative treatment or surgery depending on the severity of the condition.

The conservative approaches include:

• Heat: Applying heat to the palms of the hand prior to massage or exercise can help loosen the tissues.
• Massage: Gently massage the thickened tissues of the palm.
• Exercises: Stretching exercises, such as bending the fingers away from the palm, may be useful.
• Injections: Steroid injections may be administered to the palm to relieve local inflammation.
• Collagenase injection: An enzymatic drug that breaks down collagen can be injected into the corded tissue to soften and weaken the contracture. Your doctor can then manipulate the area to break up the tissue.
• Needle aponeurotomy: This procedure involves inserting a small needle into the thickened palm tissue and manipulating it to loosen and break up the contracting tissue. Ultrasound may be used to guide the needle to avoid hitting nerves or tendons.

Surgical procedure

If conservative treatment options fail to resolve the condition, symptoms persist for 6 months or more, and your quality of life is adversely affected, your surgeon may recommend a surgical procedure to open the tendon sheath and allow more room for tendon movement. This surgery is usually performed on an outpatient basis under local or regional anesthesia. Your surgeon makes a small incision on the affected palm area and removes the thickened fibrous tissue causing the contracture. The incision is then closed with sutures and covered with a sterile dressing.

Complications

Complications may occur and can be medical (general) or specific to the hand surgery. Medical complications include those of the anesthetic and your general well-being. Some of the complications associated with hand surgery include:

• Infection
• Nerve damage causing weakness, paralysis or loss of feeling in the hand area
• Injury to the arteries of the fingers/hand
• Recurrence of the condition