Dupuytren’s contracture is a thickening and shortening of the connective tissue underneath the skin of your palm. This leads to clawing of fingers as they are pulled towards the palm, forming a bend position.This restricts finger extension or straightening, which can complicate everyday’s activity such as buttoning up a shirt, shaking hands and handling tools.
Dupuytren’s contracture may affect one or both hands, and is most common in the ring and little finger, although any finger can be affected.
Dupuytren’s contracture is a fairly common condition, and tends to occur more in men than women.
Symptoms
If you have Dupuytren’s contracture, you will have:
- Small painless lump called a nodule on the palm of your hand
- Dimpling on the skin of the palm
- Appearance of a thickened cord on the palm
- As the cord tightens, your finger is pulled against the palm, sometimes severely, which might interfere with activities such as wearing gloves, washing and shaking hands.
- The ring finger is affected most often, followed by the little, and middle.
- Thumbs and index fingers are rarely affected.
Causes
The cause is unknown.
Genetics might play an important role. Up to 70% of people who develop Dupuytren’s contracture have a family history of this condition.
The condition becomes more common after the age of 40.
Men are affected more often than women.
Risk factors are alcoholism, epilepsy, pulmonary tuberculosis, diabetes, and liver disease.
Risk Factors
- Age. Dupuytren’s contracture occurs most common in middle to later years of life.
- Sex. Men are ten times more likely to develop this condition than women.
- Ancestry. People of Scandinavian or Northern European are at higher risk of this condition.
- Family History. 60 – 70% of those afflicted have a genetic predisposition to Dupuytren’s contracture.
- Alcoholism. Contractures tend to be more severe.
- Smoking. Changes structures within the blood vessels.
- Medical conditions. People with diabetes, liver disease and epilepsy are at increased risk.
- Manual workers or rock-climbers. Associated with constant stress and trauma to the connective tissue underneath the palm thru handling jackhammers or climbing.
- Associated Conditions. Ledderhose disease, Peyronie’s disease, Garrod’s pads.
Investigations
In most cases, doctors can diagnose Dupuytren’s Contracture by looking and feeling for the palm, especially for thickened scar tissue and contracture.
Another simple method is that if you could lay your palms flat on the tabletop, then you do not have Dupuytren’s contracture.
Other tests are rarely necessary.
Complications
Many people do not encounter any difficulties in mild Dupuytren’s Contracture. As the condition progresses, it might affect daily activities such as writing, buttoning up clothes, grasping objects. Other complications include tendon rupture, digital nerve injury, flexion contracture and infection.
Treatment
If the condition progresses slowly, causes no pain and has little impact on your daily activities, you may not need treatment. Instead, you could wait and see if Dupuytren’s contracture progresses.
They are few options available to straighten the finger(s). These include :
- Needle aponeurotomy. A needle is introduced into the skin and used to cut or weaken the tight cord. Your doctor will then manipulate your hand manually and straighten your finger. This is a day procedure. Recovery is fast and requires very little hand therapy afterwards.
- Enzyme (collagenase) injection. This enzyme dissolves and weakens the tight cord in the palm. Your doctor will then manipulate your hand manually and straighten your finger. This is a day procedure. Recovery is fast and requires very little hand therapy afterwards.
- Open surgery. Surgery is required when your doctor has confirmed over time that the condition is progressing. Surgery involves removing thickened bands to restore finger motion. Thickened tissues may also attach to skin, making it difficult to remove and increasing recurrence rate. Skin grafts are sometimes required to cover open wound. Recovery time can be long and require months of hand therapy.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
When to Contact a Medical Professional
Call your health care provider if you have symptoms of this disorder. Prevention Awareness of risk factors may allow early detection and treatment.
Prevention
Finger stretching techniques are helpful. Gently bent your fingers backwards from your palm. Protect your hands by wearing thick padded gloves when dealing with heavy grasping tasks. Use massage and heat pack on your palms before stretching.
F.A.Q. | Frequently Asked Questions
What is the prognosis?
The disorder progresses at an unpredictable rate. Surgical treatment can usually restore normal movement to the fingers. The disease can recur following surgery in some cases.
What happens after surgery?
Your doctor will bandage your hand with a dressing and splint. This will keep your fingers straight during healing. Your doctor will check your hand within 5-7 days and stitches are removed, though most would be absorbed. Always keep your hand elevated above your heart to avoid swelling and put in on a stack of pillow when sitting or sleeping.
Rehabilitation
Hand therapy involves stretching, soft tissue massage and heat treatment. These sessions are important to limit the development of scar tissue and prevent the recurrence of contracture.