Dupuytren’s Contracture

Your hands and wrists are essential tools that allow you to work, play and perform everyday activities. How well the hand and wrist interact depends on the integrity and function of the ligaments, tendons, muscles, joints and bones.

Problems in any of these can affect upper extremity function, causing disruptions at home and work and negatively impacting quality of life.

The human hand itself is very complex and delicate in structure.  At some time in life, you may experience hand or wrist pain.

Dupuytren’s contracture is a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. Although painless, the thickening and tightening (contracture) of this fibrous tissue can cause the fingers to curl (flex).

Dupuytren’s contracture is more common in men than in women.

Cause

The cause of Dupuytren’s contracture is not known. It is not caused by an injury or heavy hand use.

There are factors that put people at greater risk for developing Dupuytren’s contracture.

  • It is most common in people of Northern European (English, Irish, Scottish, French, Dutch) or Scandinavian (Swedish, Norwegian, Finnish) ancestry.
  • It often runs in families (hereditary).
  • It may be associated with drinking alcohol.
  • It is associated with certain medical conditions, such as diabetes and seizures.
  • It increases in frequency with age.

Symptoms

Dupuytren’s contracture symptoms usually occur very gradually.

Nodules

One or more small, tender lumps (nodules) form in the palm. Over time, the tenderness usually goes away.

Bands of tissue

The nodules may thicken and contract, forming tough bands of tissue under the skin.

Curled fingers

One or more fingers bend (flex) toward the palm. The ring and little fingers are most commonly affected, but any or all fingers can be involved. As the bend in the finger increases, it may be hard to straighten your finger. Grasping large objects and putting your hand in a pocket becomes difficult.

Diagnosis

Your Wisconsin Bone & Joint doctor will examine your hand and test the feeling in your thumb and fingers. Your grip and pinch strength may also be tested.

During the examination, your doctor will record the locations of nodules and bands on your palm. Using a special device, he or she will measure the amount of contracture in your fingers.

Your doctor may also measure the range of motion in your fingers to determine whether there is limitation in your flexion.
Your doctor will measure the bend in your finger, and note where the bands of tissue and nodules are.

Your doctor will refer back to these measurements throughout your treatment to determine whether the disease is progressing.

Treatment

There is no way to stop or cure Dupuytren’s contracture. However, it is not dangerous. Dupuytren’s contracture usually progresses very slowly and may not become troublesome for years. It may never progress beyond lumps in the palm.

If the condition progresses, nonsurgical treatment may help to slow the disease.

Nonsurgical Treatment

Steroid injection

If a lump is painful, an injection of corticosteroid – a powerful anti-inflammatory medication – may help relieve the pain. In some cases, it may prevent the progression of contracture. Several injections may be needed for a lasting effect.

Splints

Splinting does not prevent increased bend in the finger. Forceful stretching of the contracted finger will not help either, and may speed the progression of contracture.

Surgical Treatment

Surgery is recommended when your doctor has confirmed through measurements over time that the disease is progressing.

Some patients turn to surgical treatment when hand function is limited; they have trouble grasping objects or putting their hands in their pockets.

Surgical procedure

Surgery for Dupuytren’s contracture divides or removes the thickened bands to help restore finger motion. Sometimes the wound is left open and allowed to heal gradually. Skin grafting may be needed.

Recovery

Some swelling and soreness are expected after surgery, but severe problems are rare.

After surgery, elevating your hand above your heart and gently moving your fingers help to relieve pain, swelling, and stiffness.

Physical therapy may be helpful during recovery after surgery. Specific exercises can help strengthen your hands and help you move your fingers.

Most people will be able to move their fingers better after surgery.

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