Pacific Rim Orthopaedic Surgeons

Dupuytren's Contracture

When tissue under the skin of a person's palms and fingers thicken and tighten, a painless genetic condition known as Dupuytren contracture is the likely cause. Symptoms of the genetic disorder aren't readily apparent, taking months or years to advance. While there is no cure for Dupuytren contracture, there are treatments, both surgical and nonsurgical, that help to relieve symptoms and slow the progression.

What is Dupuytren's Contracture?

Dupuytren contracture, also known as Dupuytren disease, is a genetic disorder that causes the tissue under the skin of the palms and fingers to thicken and tighten. Nodules ( small bumps) will grow on the hand’s fascia (rubber band-like tissue that supports the hand and fingers under the skin) and eventually form thick cords beneath the skin. These thick cords cause the fingers to bend to the point they can no longer be straightened.

It’s important to note that the growths caused by Dupuytren contracture are always benign and never a symptom or cause of any cancers. While Dupuytren disease is unrelated to cancer, people with certain diseases or health conditions are more likely to develop it than others, such as:

  • HIV
  • AIDS
  • Vascular disease
  • Alcohol use disorder
  • Diabetes
  • Epilepsy and other seizure disorders

Symptoms

Dupuytren contracture only affects the hands and cannot spread or develop in other body parts. While it is related to other connective tissue disorders that can develop in other places, Dupuytren contracture is specific to the hands with no chance for it to develop elsewhere. 

As mentioned, the disease manifests in the hand and fingers, including the thumb, and is most common in fingers in the following order:

  • Ring fingers
  • Pinkie fingers
  • Middle fingers
  • Index fingers
  • Thumb

Other symptoms that may be present in the hand include:

  • Inflammation or swelling
  • Pain or burning
  • Tenderness
  • Itching

Dupuytren contracture symptoms aren’t usually noticed at first, but as the disease develops, they appear in this order:

  1. Nodules: small bumps under the skin of the palm, usually at the base of the fingers where they meet the palm. While some people never develop symptoms beyond nodules, when they do develop they can usually be seen or felt. They tend to make the skin around them look puckered or simplified. 
  2. Cords: the nodules can develop into thick cords of tissue that pull on the fingers and make it feel like they’re being constantly pulled in toward the palm.
  3. Contracture: this is the most advanced system, where the cords grow so tight and thick that it may be impossible to extend or straighten the affected fingers.

It’s important to note that these symptoms are rare and when do manifest, may indicate other issues that are affecting the skin or fascia. 

Causes

Dupuytren contracture is rare, with only 5% of people developing it, but is more often found in people of European descent than other ethnic groups. The direct cause is unknown, but is more likely to develop if a member of the family has it as it’s a genetic disorder. 

Diagnosis & Treatment

To diagnose Dupuytren disease, a healthcare provider will perform a physical exam, feeling for nodules and cords that may have developed, and measure how severe the contracture is. While there aren’t any specific tests to diagnose the condition, blood tests or X-rays may be ordered to look for other possible conditions that may be affecting your hands. 

Treatment and Management Options

Dupuytren contracture treatment is performed in stages and depends on how severe the symptoms are. This is due to the condition developing so slowly, that symptoms might be resolved with early treatment and not require additional ones. If the symptoms come back, then treatment would be repeated. 

Treatment options for Dupuytren contracture include:

  • Conservative treatments:
    • physical therapy
    • Bracing or splinting to stretch the fingers to their usual range of motion
    • Ultrasonic or heat treatments for flexibility
    • Corticosteroid injections to shrink nodules and cords
  • Radiation therapy: to prevent the symptoms from progressing, a patient may be recommended to a radiation specialist who will aim X-rays or other beams at the nodules or cords to soften them. 
  • Needle aponeurotomy: also known as percutaneous needle fasciotomy, is an outpatient procedure that a healthcare provider can perform in their office. The hand will be numbed and holes poked into the hand’s fascia to release tension and straighten the fingers.
  • Collagenase injections: collagenase is injected into the nodules or cords to help loosen and break down the growths. This injection is followed by another appointment where the hand and affected fingers are stretched back out.
  • Dupuytren contracture surgery: If the contracture has become so severe that it interferes with day-to-day life, surgery may be needed. The surgery is outpatient and called a fasciectomy. The hand is numbed with local anesthetic and the affected fascia is removed. How much is taken depends on how much of the fascia has thickened. Occupational therapy can be needed following the surgery to ensure the joints return to their normal strength. 

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