Dupuytren contracture is a hand condition where one or more of your fingers bend towards your palm.
- In Dupuytren contracture, the connective tissue under your skin (the fascia) covering the tendons in your palm becomes thickened and scarred. If it progresses, one or more fingers bend (contract) into your palm and you cannot straighten the finger. This is called contracture.
- It commonly affects the ring fingers of both hands, followed by the little fingers. It can also happen in one hand only.
- There are different forms of the condition where the progress is slower or faster.
- Dupuytren contracture usually affects men in their mid-50s and women in their mid-60s.
- It is not usually painful. Treatment is only needed if the contracture progresses enough to stop you being able to do things in your daily life.
Image credit: 123rf
What causes Dupuytren contracture?
Dupuytren contracture is caused by thickening and scarring of connective tissue under the skin (fascia) covering the tendons in your palm.
The exact cause for this to happen is unknown. It may occur due to your genes or immune system. Other factors may play a role, but their effects are unclear. These include:
- previous hand injuries
- occupations that are exposed to excessive vibration
- drinking too much alcohol
- high cholesterol.
Dupuytren contracture is more common in people of European ancestry and may run in your family. It affects men more than women at a ratio of 7:1. In some cases, contracture in your hand may be accompanied by the presence of nodules in your feet and/or the development of scar tissue in your genitalia.
What are the symptoms of Dupuytren contracture?
Symptoms of Dupuytren contracture are different at different stages of the condition.
- In the early stages, you may find small hard nodules or lumps in your palm. These are often painless.
- You may feel some tightness and tenderness in your palm and fingers.
- If the nodules or lumps are painful, the pain often goes away over time.
- As the disease progresses, the small nodules or lumps can become a cord of tissue.
- The cord of tissue then starts to contract causing the bending of your fingers towards your palm.
- You may feel it is difficult to straighten your fingers.
- You may also notice some skin changes around the affected area, such as dimpling and wrinkling.
- If your fingers become bent, it can limit your daily activities.
How is Dupuytren contracture diagnosed?
Dupuytren contracture is diagnosed through taking a history from you and examining your hand. Tests such as blood tests, X-rays or scans are usually not needed, unless your doctor thinks your symptoms are due to other causes.
How is Dupuytren contracture treated?
Treatment of Dupuytren contracture is only needed if the condition affects your daily life and you cannot do things normally. Physiotherapy, splints, exercises or steroid injections don't seem to be helpful in Dupuytren disease. Instead, if the condition has progressed enough, surgery may be carried out to release the contracture. Surgery aims to restore the functioning to your hand.
If surgery is an option for you, your doctor will refer you to a surgeon to discuss the different surgical options available, the benefits and risks of each procedure, and what to expect.
In New Zealand, there are 2 types of surgical procedures commonly performed for Dupuytren disease. These are:
- needle fasciectomy.
Fasciectomy involves making a cut on your palm to remove the scarred tissue so that your finger can be straightened. It can be done using either general or local anaesthesia. This procedure has the lowest risk of contractures coming back.
A needle is inserted through the skin into your palm to break the scar tissue and release the contracture. This procedure is usually done using local anaesthesia. Contractures are more likely to come back following this procedure than with fasciectomy.
What is the outlook for someone with Dupuytren contracture?
There is no treatment that can cure Dupuytren contracture completely. Without treatment, the condition progresses slowly over months to years.
The following links provide further information about Dupuytren contracture. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
- Watt AJ, Curtin CM, Hentz VR. Collagenase injection as nonsurgical treatment of Dupuytren's disease: 8-year follow-up. J Hand Surg 2010; 35: 539–9.e1.
- Dupuytren disease Auckland HealthPathways, NZ
- Dupuytren contracture HealthInfo Canterbury, NZ
- Dupuytren contracture DermNet, NZ
- Dupuytren's contracture Southern Cross, NZ
- Dupuytren's contracture NHS, UK
|Miranda Bűhler is a physiotherapist and hand therapist with 20 years’ clinical experience. She works at Southern District Health Board. Her clinical and research interests cover a wide range of post-traumatic and long-term conditions involving the hand and upper limb. She is currently completing her PhD at the University of Otago.|