Dupuytren’s Contracture

Introduction

Dupuytren’s disease causes an abnormal thickening of the tissues located underneath the skin in the palm of the hand. As the tissue thickens it can form lumps and strong cords. The abnormal growth causes the fingers to bend in towards the palm of the hand. Severe symptoms can cause contractures and loss of hand function. Dupuytren’s disease generally progresses slowly, but progression is unpredictable.

Anatomy

The palm of your hand contains ligaments and tendons. Ligaments are strong bands of tissues that connect your bones together. Tendons attach muscles to bone. The tendons in the palm of your hand flex or bend your fingers inward. Your ligaments and tendons are covered and kept in place by the palmar fascia, a thin sheet of connective tissue. The palmar fascia is located just beneath your skin.

Causes

The cause of Dupuytren’s disease is unknown. It may be associated with abnormal biochemical processes in the palmar fascia. It is more common in people of Northern European descent. It occurs more frequently in men than in women. Dupuytren’s disease is rare among young people and more common in people over 40 years old. If it occurs in young people, the condition tends to be very severe and quickly progressing.

Smoking and drinking alcohol increase the risk of Dupuytren’s disease. Certain medical conditions are associated with an increased risk of Dupuytren’s disease. Such conditions include diabetes, thyroid problems, epilepsy, pulmonary tuberculosis, and liver disease.

Symptoms

The onset of Dupuytren’s disease is very slow. Both hands may be affected but usually one hand is more affected than the other. You may notice a small tender lump in the palm of your hand. The tenderness will go away as Dupuytren’s disease typically is not painful. Over time, tough cords may form beneath your skin. The thickened tissue may cause your fingers to bend inward toward your palm. Your ring finger and little finger are affected most often. You may have difficulty straightening your fingers.

The progression of Dupuytren’s disease is unpredictable. For some, the condition may consist of a lump or thickening of the tissue. Other people may experience severe symptoms, including contractures and loss of hand function.

Diagnosis

Your doctor can diagnose Dupuytren’s disease by examining your hand. You should tell your doctor about any symptoms and if they restrict the use of your hand. Your doctor will look at and feel the skin on the palm of your hand for thickened tissue or nodules. Your doctor will observe your finger positioning and test the movement of your finger joints. You may be asked to perform the Table Top Test, in which you will attempt to place your open hand on a surface and flatten your palm and fingers out as far as you can. This will be difficult in the presence of finger contractures.

Treatment

There is no way to stop the progression of Dupuytren’s disease. Your doctor will monitor the progress of your disease. Injections may help relieve the pain in a lump that has formed early in the disease process. Surgery is recommended if the fingers become flexed enough to interfere with the functional use of your hand.

Injectable enzymes to dissolve the diseased tissue were FDA approved in 2010. The product is called Xiaflex. Studies and ongoing use of the enzyme have shown success in treating finger contractures caused by Dupuytrens Disease.

Surgery

The goal of surgery is to increase the movement of your fingers and restore their correct positions to improve hand functioning. There are several different options for this. Your surgeon may simply divide the thickened bands in a procedure called fasciotomy. Your surgeon may remove the sheet of diseased palmar fascia in a procedure called fasciectomy. In some cases, a skin graft may be necessary.

Recovery

Following surgery, you will participate in rehabilitation with a hand therapist who will instruct you in strengthening and stretching exercises. You may receive therapy treatments to reduce swelling and ease pain. Your hand therapist will provide you with a splint to position your hand and promote healing.

Surgery is not always a permanent solution for Dupuytren’s Disease. The condition tends to gradually recur over time.