Dupuytren's Contracture

Overview

Dupuytren’s (du-pwe-TRANZ) contracture is a hand deformity that usually develops over years. The condition affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin — eventually creating a thick cord that can pull one or more fingers into a bent position.

The affected fingers can’t be straightened completely, which can complicate everyday activities such as placing your hands in your pockets, putting on gloves or shaking hands.

Dupuytren’s contracture mainly affects the two fingers farthest from the thumb, and occurs most often in older men of Northern European descent. A number of treatments are available to slow the progression of Dupuytren’s contracture and relieve symptoms.

Symptoms

Dupuytren’s contracture typically progresses slowly, over years. The condition usually begins as a thickening of the skin on the palm of your hand. As it progresses, the skin on your palm might appear puckered or dimpled. A firm lump of tissue can form on your palm. This lump might be sensitive to the touch but usually isn’t painful.

In later stages of Dupuytren’s contracture, cords of tissue form under the skin on your palm and can extend up to your fingers. As these cords tighten, your fingers might be pulled toward your palm, sometimes severely.

The two fingers farthest from the thumb are most commonly affected, though the middle finger also can be involved. Only rarely are the thumb and index finger affected. Dupuytren’s contracture can occur in both hands, though one hand is usually affected more severely.

Causes

Doctors don’t know what causes Dupuytren’s contracture. There’s no evidence that hand injuries or occupations that involve vibrations to the hands cause the condition.

Risk factors

A number of factors are believed to increase your risk of the disease, including:

• Age. Dupuytren’s contracture occurs most commonly after the age of 50.
• Sex. Men are more likely to develop Dupuytren’s and to have more severe contractures than are women.
• Ancestry. People of Northern European descent are at higher risk of the disease.
• Family history. Dupuytren’s contracture often runs in families.
• Tobacco and alcohol use. Smoking is associated with an increased risk of Dupuytren’s contracture, perhaps because of microscopic changes within blood vessels caused by smoking. Alcohol intake also is associated with Dupuytren’s.
• Diabetes. People with diabetes are reported to have an increased risk of Dupuytren’s contracture.

Complications

Dupuytren’s contracture can make it difficult to perform certain functions using your hand. Since the thumb and index finger aren’t usually affected, many people don’t have much inconvenience or disability with fine motor activities such as writing. But as Dupuytren’s contracture progresses, it can limit your ability to fully open your hand, grasp large objects or to get your hand into narrow places.

Diagnosis

In most cases, doctors can diagnose Dupuytren’s contracture by the look and feel of your hands. Other tests are rarely necessary.

Your doctor will compare your hands to each other and check for puckering on the skin of your palms. He or she will also press on parts of your hands and fingers to check for toughened knots or bands of tissue.

Your doctor also might check to see if you can put your hand flat on a tabletop or other flat surface. Not being able to fully flatten your fingers indicates you have Dupuytren’s contracture.

Treatment

If the disease progresses slowly, causes no pain and has little impact on your ability to use your hands for everyday tasks, you might not need treatment. Instead, you can wait and see if Dupuytren’s contracture progresses. You may wish to follow the progression with a tabletop test, which you can do on your own.

Treatment involves removing or breaking apart the cords that are pulling your fingers toward your palm. This can be done in several ways. The choice of procedure depends on the severity of your symptoms and other health problems you may have.

Needling

This technique uses a needle, inserted through your skin, to puncture and break the cord of tissue that’s contracting a finger. Contractures often recur but the procedure can be repeated.

The main advantages of the needling technique are that there is no incision, it can be done on several fingers at the same time, and usually very little physical therapy is needed afterward. The main disadvantage is that it can’t be used in some places in the finger because it could damage a nerve or tendon.

Enzyme injections

Injecting a type of enzyme into the taut cord in your palm can soften and weaken it — allowing your doctor to later manipulate your hand in an attempt to break the cord and straighten your fingers. The FDA has approved collagenase Clostridium histolyticum for this purpose. The advantages and disadvantages of the enzyme injection are similar to needling. Enzyme injections are not offered at all medical institutions.

Surgery

Another option for people with advanced disease, limited function and progressing disease is to surgically remove the tissue in your palm affected by the disease. The main advantage to surgery is that it results in a more complete and longer-lasting release than that provided by the needle or enzyme methods. The main disadvantages are that physical therapy is usually needed after surgery, and recovery can take longer.

In some severe cases, especially if surgery has failed to correct the problem, surgeons remove all the tissue likely to be affected by Dupuytren’s contracture, including the attached skin. In these cases a skin graft is needed to cover the open wound. This surgery is the most invasive option and has the longest recovery time. People usually require months of intensive physical therapy afterward.

Lifestyle and home remedies

If you have mild Dupuytren’s contracture, you can protect your hands by:

• Avoiding a tight grip on tools by building up the handles with pipe insulation or cushion tape
• Using gloves with heavy padding during heavy grasping tasks

However, your condition may persist or worsen, despite these precautions.

Preparing for your appointment

While you might first bring your symptoms to the attention of your family doctor, he or she might refer you to a specialist doctor.

What you can do

Before your appointment, you might want to write a list that answers the following questions:

• Do you have a family history of this problem?
• What treatments have you tried? Did they help?
• What medications and supplements do you take regularly?

What to expect from your doctor

Your doctor might ask some of the following questions:

• When did your symptoms begin?
• Have they been getting worse?
• Is your hand painful?
• How does the contracture interfere with your day-to-day tasks?