We often take for granted how much our hands can accomplish, from opening pickle jars to reaching into a pocket to grab some change. For people with the hand deformity Dupuytren's contracture (pronounced du-pwe-TRANZ), these seemingly simple tasks pose much bigger challenges.
What Is Dupuytren's Contracture?
Dupuytren's contracture is a condition that causes thick, tough tissue to form under the skin of the palm. The thickened, shortened tissue eventually forces some of the fingers to curl inward toward the palm, creating a hand deformity.
The incidence of Dupuytren's contracture is still highest in northern European countries like Norway, Scotland, Ireland, Iceland, and Sweden.
Swiss doctor Felix Platter was the first to describe Dupuytren's contracture in the 1600s. Many years later, the condition was named for French surgeon Baron Guillaume Dupuytren, who gave a now-famous lecture on retracted fingers in 1831.
What Causes Dupuytren's Contracture?
More than three centuries have passed since Dupuytren's was first discovered, yet doctors still don't know exactly what causes the condition. They believe that at least some cases are hereditary, but Dupuytren's may also be associated with drinking alcohol and medical conditions like diabetes and seizures.
Dupuytren's Contracture Symptoms
The first sign of Dupuytren's contracture is a hard knot or lumps of connective tissue that form under the skin of the palm. These lumps might feel tender to the touch, but they usually aren't painful. Over a period of many years, the knots become bands of thick tissues. The bands extend up the fingers -- usually the ring and pinky fingers, although other fingers can be affected.
As the bands tighten, they pull the involved fingers in toward the palm. Eventually it becomes impossible to fully straighten the fingers. The shortening of the fingers caused by the thick tissue is called contracture.
Both hands can be affected by Dupuytren's contracture, but one hand is usually more severe than the other.
The hand deformity makes it harder to grasp large objects. You may have more trouble doing things like opening jars or doors or combing your hair. You should still be able to pick up small objects, because the thumb and index finger usually aren't involved.
The palm is the most common site of Dupuytren's contracture. However, Dupuytren's can be associated with conditions that cause contractures in other areas of the body, including the:
- Knuckle pads (Garrod knuckle pads)
- Soles of the feet (Ledderhose disease)
- Penis (Peyronie's disease)
Tests for Dupuytren's Contracture
Your doctor should be able to tell that you have Dupuytren's contracture just by looking at your bent fingers and feeling the tissue on your palm. The doctor might also check the strength and range of motion in your affected hand.
One test that can help diagnose the condition and determine whether you need surgery is the "table top" test. During this test, place your hand, palm side down, on a table. If the hand does not lie flat, the symptoms of Dupuytren's contracture are probably significant enough that you need to have surgery.
Dupuytren's Contracture Treatment
If Dupuytren's contracture isn't bothering you much, you shouldn't need treatment. However, if Dupuytren's is interfering with your daily activities, your doctor may recommend one of these treatments:
- Stretching exercises for very mild cases
- Steroid injections to help bring down inflammation and possibly slow the course of the disease (they don't actually straighten the finger.)
Enzyme Injections
If your fingers are already bent, collagenase (Xiaflex), a mixture of enzymes that help dissolve the tough tissue, may be injected into the affected area by your doctor. This weakens the tight bands and may allow your doctor to then stretch the tightened area and straighten your finger. Most people need one or two injections in the affected joint, but some people may need up to three injections to straighten or nearly straighten the finger. The most common side effects are swelling in the affected area, or bleeding, bruising, and pain at the injection site. Rarely, more serious side effects, such as damage to a tendon, nerve injury, or allergic reaction, may occur.
Surgery
When surgery is called for, the surgeon performs a fasciotomy in which tissue from the palm is removed through an incision. Then the open wound is allowed to heal on its own, or it is covered with a skin graft taken from another part of your body. The hand is often splinted after surgery to help with healing.
Surgery for Dupuytren's can have risks, including:
- Damage to nerves and blood vessels in the affected fingers
- Infection
- Permanent stiffness in the fingers
It can take two months or more to fully return to your normal activities after surgery. Try to keep moving your fingers to relieve pain and stiffness. Massaging your fingers or applying heat can also help with movement and discomfort. A physical therapist can teach you exercises to help you regain the motion in your hand.
Dupuytren's contracture eventually comes back in up to half of people who have surgery. If the thickened tissue develops again, you might need another procedure.
A less invasive Dupuytren's contracture treatment that some surgeons are now using is called needle aponeurotomy, formerly known as needle fasciotomy. This procedure is done in the doctor's office using local anesthesia. The surgeon uses a needle to split the bands of tissue.
Because the technique doesn't use open cuts, there is less risk of infection and injury, and recovery is usually quicker than with open surgery. However, the surgeon has to be very specialized to perform a needle aponeurotomy. And because this procedure is still relatively new, doctors still aren't sure of the long-term outcome.