Overview

What is Dupuytren's contracture?

Dupuytren's contracture, also known as Dupuytren's disease, is an abnormal thickening of the skin on the palm of your hand at the base of your fingers. This thickened area may grow into a firm lump or thick band. Gradually, it can cause one or more fingers to curl (contract) or pull sideways or inward toward your palm.

The ring and little fingers are most typically involved. In many patients, it affects the hands on both sides. An infrequent presentation involves the feet.

What are the symptoms of Dupuytren's contracture?

Common signs may include:

• You can't place your hand flat on a table, palm down (the tabletop test)
• You have one or more small, sore lumps (nodules) in the palm. Nodules usually do not hurt over time.
• The nodules thicken and contract or tighten; this results in thick bands of tissue under the skin in the palm of the hand.
• Cavities or furrows in the skin compressed by the contracted finger. These can become very sore and cause skin loss if not healing properly.
• Fingers are pulled forward.
• Fingers are pulled forward.
• Your hand becomes less functional.

The symptoms of Dupuytren's contracture may resemble those of other health problems. Always see your healthcare provider for a diagnosis.

What causes Dupuytren's contracture?

The cause of Dupuytren's contracture is unknown but may be associated with smoking cigarettes, alcoholism, diabetes, nutritional deficiencies, or medicines used to treat seizure disorders. Heredity is thought to contribute to Dupuytren's contracture.

How is Dupuytren's contracture diagnosed?

Your physician will examine your hand. She or he will check the flexibility and sensation in your thumb and fingers. He or she may also check your grip and pinch strength.

Nodules and bands are measured with a ruler and noted where they occur by your healthcare provider. A special tool will be used to estimate how much your fingers are curling in or contracting. Your healthcare provider may also observe the range of motion of your fingers.

These measurements are compared with later measurements to see if the disease worsens. They can also be used to see if treatment is effective.

How is Dupuytren's contracture treated?

Your doctor will work with you to develop a treatment plan specifically for you based on the following:

• Your age, general health, and medical history.
• How advanced is your condition?
• How well do you tolerate certain medications, treatments, or therapies?
• Whether your condition will worsen?
• What do you want to do?

Dupuytren's contracture has no cure and is not dangerous. Many people do not seek treatment, but it may slow the progression of the disease or alleviate symptoms.

Some potential treatments are:

• Surgery: This is the most common treatment in advanced cases. It can be performed whenever you have limited use of your hand. In this process, your hand is cut by the surgeon, and the thickened tissue is gotten rid of. This may then improve the mobility of your fingers. Some have the contractures come back. They have to undergo it again.
• Steroid injection: In some cases, especially for painful lumps, a series of steroid injections may help reduce the pain; in some cases, it might even stop your condition from getting worse. Sometimes, you may need multiple injections.
• Radiation therapy: This is less common in the U.S. The nodules are exposed to low-level X-rays. This is most effective in early disease. It can make the nodules softer and may prevent contractures from taking place.
• Enzyme injection: This is a newer, more minimally invasive procedure performed by highly specialized surgeons. On the first visit, your healthcare provider injects an enzyme medicine into the mass of tissue. The tough bands are broken down and dissolved by the enzyme over several hours. The next day, generally 1 to 2 days later, the medical practitioner will visit; administer some numbing medicine to the hand, and stretch the finger joints slowly and completely to break the cord.
• Needle aponeurotomy: This is a newer, less invasive procedure, often utilized for more mild contractures. Medication is placed locally in the hand to cause numbness. The diseased tissue is then divided using a needle by the surgeon. No incision is needed.

Who is most at risk of having a Dupuytren's contracture?

You are at a higher risk of this condition if you:

• Are over forty: It generally begins in the middle-aged years.
• Are male: It is more common among males than females.
• Family history: Family history is also common; therefore, the condition may be inherited.
• On seizure medication: The condition is associated with some of the medicines used in managing epileptic seizures.
• Smoking or alcoholism.
• Diabetes.

What are the complications of Dupuytren's contracture?

Gradually, you may find you cannot use your hand to do specific jobs. For instance, you cannot fully reach for something significant or extend your fingers.

How long does Dupuytren's contracture last?

Because it progresses over months or even years, perhaps it is easier to think of Dupuytren’s contracture as a continuum of symptoms you have or haven't developed yet rather than a disease by any other name that has duration.

You may develop Dupuytren's contracture again after treatment. But if you do, your provider will then be able to treat it exactly the same way as last time.

When should I see my doctor?

If your symptoms worsen, talk to your provider. The sooner you get treated, the more likely you are to relieve your symptoms before they worsen.

The tabletop test is a good way to check how your symptoms are deteriorating. If you put your hand on a flat surface with your palm down and your affected fingers do not lie flat on that surface, you likely will have deteriorating symptoms. See your provider for treatment.

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