What is Dupuytren's contracture?
Dupuytren's contracture, also called Dupuytren's disease, usually begins with a thickening of the skin in the palm of the hand, which may develop into a hard lump or thick band that eventually could cause the fingers to contract, or pull into the palm.
This condition is a thickening of the fascia on the palm of the hand. The fascia is a connective tissue located just beneath the skin of the palm and fingers. This thickened fascia can form lumps or nodules under the skin, or long thick cords of tissue that extend from the palm to the fingers. Often, this thickened tissue contracts. This causes one or more fingers to curl toward the palm. This is called a flexion contracture.
What causes Dupuytren's contracture?
Dupuytren's contracture is thought to be a hereditary disease, which means it is inherited from the family, but the exact cause is unknown. It may be associated with cigarette smoking, epilepsy, diabetes, and alcoholism, and usually presents in middle age.
Facts about Dupuytren's contracture
Consider the following statistics related to Dupuytren's contracture:
The ring and little fingers are the most commonly affected fingers.
One, two, or more fingers may be affected.
It is most common in people of Northern European (English, Irish, Scottish, French, Dutch) or Scandinavian (Swedish, Norwegian, Finnish) descent.
What are the symptoms of Dupuytren's contracture?
The following are the most common symptoms of Dupuytren's contracture. However, each individual may experience symptoms differently. Symptoms may include:
One or more small, tender lumps (nodules) form in the palm. Over time, the tenderness usually goes away.
The nodules may thicken and contract, leading to the development of thick tissue under the skin in the palm of the hand.
Finger(s) are pulled forward
Decrease in hand function
The symptoms of Dupuytren's contracture may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.
Treatment for Dupuytren's contracture
Specific treatment for Dupuytren's contracture will be determined by your doctor based on:
Your age, overall health, and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
If a lump is painful, a steroid injection--a powerful anti-inflammatory medication--may help relieve the pain. In some cases, it may prevent the progression of contracture. Repeated injections may be needed for lasting effect.
At the present time, surgery is the only treatment available to help correct advanced Dupuytren's contracture. While surgery may increase the mobility of the finger(s), it does not correct the underlying disease process.
During the surgery, the surgeon makes an incision in the hand and cuts the area of thickened tissue. This allows for improved movement of the tendons and increases finger mobility. It is a very precise surgery because the nerves in the hand are often in this area of thickened tissue. Sometimes, skin grafts are needed to correct the overlying skin. This involves replacing or attaching skin to a part of the hand that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area.
After surgery, physical therapy for the affected hand will be implemented to help increase strength and function.
About 20 percent of patients have some degree of recurrence that may require further surgery.
An enzyme injection has recently been approved by the FDA for treatment of Dupuytren's contracture. The enzyme breaks down the tough bands and helps improve motion without surgery. It is only given by surgeons trained in the technique, usually in the doctor's office. After numbing the hand with a local anesthetic injection, the enzyme dissolves the contracted tissue, allowing the finger to straighten. Early results are promising, but long-term recurrence rates have not yet been reported.
Needle aponeurotomy is another new, less invasive procedure offered by surgeons who are specially trained in the technique. After numbing the hand with a local anesthetic injection, the surgeon uses a hypodermic needle to divide the diseased tissue. No incision is needed and this procedure can also be done in the doctor's office. Early results appear equivalent to surgery, but, again, long-term recurrence rates are unknown.