What is Dupuytren's contracture?
Dupuytren's contracture (also called Dupuytren's disease) is an abnormal thickening of fascia, a layer of tissue under the skin, in the palm of your hand at the base of your fingers. This thickened area may develop into a hard lump or thick band. Over time, it can cause one or more fingers to curl (contract), or pull sideways or in toward your palm.
The ring and little fingers are most commonly affected. In many cases, it affects both hands. Rarely, feet may also be affected.
What causes Dupuytren's contracture?
Dupuytren's contracture is believed to run in families (be hereditary). The exact cause is not known.
It may be linked to cigarette smoking, alcoholism, diabetes, nutritional deficiencies, or medicines used to treat seizures.
Who is at risk for Dupuytren’s contracture?
You may be at greater risk for Dupuytren’s contracture if you:
- Are older. The condition usually starts in middle age.
- Are male. It is more common in men than women.
- Have a Scandinavian or Northern European background. It is most common in people whose families come from these regions.
- Have a family history. The condition is often found in families, so it may be inherited.
- Take seizure medicine. It is linked with some medicines used to treat epileptic seizures.
- Smoke or abuse alcohol
- Have diabetes
What are the symptoms of Dupuytren's contracture?
Common symptoms may include:
- Not being able to lay your hand flat on a table, palm down (called the tabletop test)
- One or more small, tender lumps (nodules) in the palm. Over time, the tenderness usually goes away.
- The nodules may thicken and contract or tighten. This can cause thick bands of tissue under the skin in the palm of the hand.
- Pits or grooves in the skin compressed by the contracted finger. These areas can become very sore and can lead to skin loss if they don’t heal properly.
- Fingers are pulled forward
- Your hand is not able to work as well
The symptoms of Dupuytren's contracture may look like other health problems. Always see your healthcare provider for a diagnosis.
How is Dupuytren’s contracture diagnosed?
Your provider will examine your hand. He or she will test the flexibility and feeling in your thumb and fingers. Your grip and pinch strength may also be tested.
Your provider will measure and record the locations of nodules and bands on your palm. Using a special tool, he or she will measure how much your fingers are curling or contracting. Range of motion in your fingers may also be measured.
These measurements will be compared to later measurements to see if the disease gets any worse. They can also be used to see if treatment is working.
How is Dupuytren's contracture treated?
Your healthcare provider will create a care plan for you based on:
- Your age, overall health, and past health
- How serious your case is
- How well you handle certain medicines, treatments, or therapies
- If your condition is expected to get worse
- What you would like to do
There is no cure for Dupuytren’s contracture. The condition is not dangerous. Many people don’t get treatment. But treatment for Dupuytren's contracture can slow the disease or help ease your symptoms.
Treatments for Dupuytren's contracture may include:
- Surgery. This is the most common treatment used for advanced cases. It may be done when you have limited use of your hand. During Dupuytren's contracture surgery, the surgeon makes a cut (incision) in your hand and takes out the thickened tissue. This can improve the mobility of your fingers. Some people have contractures return. They may need surgery again.
- Steroid shot (injection). If a lump is painful, a steroid injection may help ease the pain. In some cases, it may stop your condition from getting worse. You may need repeated injections.
- Radiation therapy. This treatment is not as common in the U.S. Low energy X-rays are directed at the nodules. This works best in the early stage of the disease. It can soften the nodules and help keep contractions from happening.
- Enzyme injection. This is a newer, less invasive procedure done by specially trained surgeons. Your doctor injects a medicine into the area to numb the hand. Then the enzyme is injected into the lump of tissue. Over several hours, the enzyme breaks down and dissolves the tough bands. This lets the fingers straighten when the cord is snapped by the surgeon, usually the next day.
- Needle aponeurotomy. This is another newer, less invasive procedure. Medicine is injected into the area to numb the hand. The surgeon uses a needle to divide the diseased tissue. No incision is made.
What are the complications of Dupuytren’s contracture?
Over time, you may have trouble using your hand for certain tasks. You may not be able to grasp large objects or straighten your fingers.
When should I call my healthcare provider?
Call your healthcare provider if your symptoms get worse or you have new symptoms.
Key points about Dupuytren's contracture
- Dupuytren's contracture is an abnormal thickening of tissues in the palm of the hand.
- The thickened tissues may develop into a hard lump. Over time it can cause 1 or more fingers to curl (contract) or pull in toward the palm.
- You may not be able to use your hand for certain things.
- In many cases, both hands are affected.
- There is no cure, but treatment can improve symptoms.