Dupuytren’s contracture
Dupuytren’s contracture (also called Dupuytren’s disease) is an abnormal thickening of the skin of the palm of the hand at the base of the fingers. Knots of tissue form under the skin, creating a thick cord that can cause one or more fingers to curl in toward the palm or pull sideways in a bent position, typically the ring finger and little finger.
Dupuytren’s contracture runs in families, particularly those of northern European descent.
Common symptoms of Dupuytren’s contracture
As the condition affects the fibrous connective tissue beneath the skin, these symptoms may occur:
- Fingers are pulled toward the palm, or sideways.
- Hand is not able to work as well.
- Inability to lay your hand flat on a table, palm down.
- One or more small, sore lumps or nodules in the palm. Over time, the soreness usually goes away. The nodules may thicken and contract or tighten, causing 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 well.
For certain people, the condition may never progress beyond developing lumps in the palm.
Some patients with Dupuytren’s disease may develop thickened tissue on the feet, called Ledderhose disease, or on the penis, called Peyronie’s disease.
Numbness is not a typical symptom and may be a sign of something else. Your provider will perform diagnostic tests to see if you’ve developed Dupuytren’s disease as opposed to arthritis, and will work with you on the best treatment plan for your symptoms.
Non-surgical and surgical treatments for Dupuytren’s
Any treatment involves removing or breaking apart the cords that are pulling your fingers toward your palm, which can be done in several ways.
Nonsurgical treatments
If your symptoms are not severe, your doctor may first recommend nonsurgical treatment to help slow the disease and return function. These treatments might include:
Corticosteroid injection. This powerful anti-inflammatory medication can relieve a painful nodule and, in some cases, can slow the progression of a contracture.
Enzyme injection. A collagenase is injected directly into the cords in your hand, which will weaken and dissolve the contracted tissue over the following 24 to 72 hours.
Needle aponeurotomy. Your doctor weakens and ruptures the diseased tissue by passing a needle back and forth through the restricted cords.
Splinting. Forceful stretching of the contracted finger may not be helpful and, in fact, could cause an injury to the finger or hand. A splint prevents further damage.
Surgical treatments
If your contracture interferes with hand function, your doctor may recommend surgical treatment:
Fasciotomy. Your doctor makes an incision in your palm to access the palmar fascia, and divides the thickened cords of tissue. You will need to wear a splint during your recovery.
Subtotal palmar fasciectomy. Your doctor removes as much of the abnormal tissue and cords as possible in the palmar fascia in order to straighten your fingers. This is a more extensive procedure than a fasciotomy, and you may or may not have to wear a splint during your recovery.
Living with Dupuytren’s disease
Your personalized treatment plan will relieve your symptoms and return proper movement to your fingers and hand, especially if you have surgery. But, because there is no cure, we know that about 20% of patients will experience a recurrence of symptoms.
Your treatment plan will address this and how to live with the condition in the long term, which may include a referral to clinical studies that explore the latest treatment techniques.
References
Orthoinfo: American Academy of Orthopaedic Surgeons. Dupuytren’s Disease (https://orthoinfo.aaos.org/en/diseases–conditions/dupuytrens-disease/)
American Society for Surgery of the Hand. Dupuytren’s Contracture (https://www.assh.org/handcare/condition/dupuytrens-contracture)
MedlinePlus: National Library of Medicine. Dupuytren contracture (https://medlineplus.gov/genetics/condition/dupuytren-contracture/)