• Dupuytrens Contracture

    Definition

    Dupuytrens contracture is a thickening and shortening of the fascia in the palm of the hand. The fascia is a firm tissue that lies just below the skin. This condition causes affected fingers to curl towards the palm and makes extension of these fingers difficult or impossible.
    Dupuytren's Contracture Scarring
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    Causes

    The exact cause of Dupuytrens contracture is unknown. For some people, the condition is inherited.

    Risk Factors

    This condition is more common in men and those over 40 years of age.
    Factors that may increase your chances of getting Dupuytrens contracture include:
    • A parent with Dupuytrens contracture
    • Hand trauma
    • Manual labor
    • Vibration exposure at work
    • Alcohol use disorder
    • Epilepsy
    • Use of certain anticonvulsant medications for epilepsy
    • Liver disease
    • Smoking
    • Diabetes

    Symptoms

    At first, symptoms of finger curling are mild, but they may worsen over time. The rate of progression varies among people.
    The ring finger is usually affected first, followed by the little finger, then the index, and long finger. Fingers on either or both hands can be affected. The first physical sign of this condition is a nodule in the palm near the base of a finger. A nodule is a small thickening of the fascia under the skin. In some cases, nodules can be sensitive to touch. Generally, though, this condition is not painful.
    As a contracture progresses, the nodule becomes a thickened fibrous cord that extends into the finger under the skin. As the cord thickens and shortens, the affected finger is pulled (curled) in towards the palm. It becomes difficult or impossible to extend the finger.

    Diagnosis

    You will be asked about your symptoms and medical history. A hand examination will be done.
    Images may be taken of your hand. This can be done with:

    Treatment

    No treatment is necessary when symptoms are mild and do not effect normal use of the hand. In other cases, treatment may include:

    Surgery

    Surgery is most effective when the condition is still in the nodule stage.
    Depending on how far the condition has progressed, surgery may involve:
    • Making small incisions in the thickened tissue
    • Removing diseased tissue
    • Removing diseased tissue and overlying damaged skin, and then repairing resulting gaps in skin with skin grafts
    • Percutaneous needle fasciotomy
    Dupuytrens contracture can recur after surgery.

    Exercise Therapy After Surgery

    This is usually needed to restore full range of motion and use of the repaired finger(s).

    Injected Medication

    Injecting corticosteroids into nodules during early stages of the condition can sometimes:
    • Delay the progressive worsening of the condition
    • Ease any tenderness that may be present in the nodules
    Another medication that can be injected is called collagenase clostridium histolyticum. This biologic drug breaks down the thickened tissue in the hand.

    Prevention

    There are no guidelines to prevent Dupuytrens contracture. Its cause is unknown. However, treatment is made easier and more effective with early detection.

    RESOURCES

    American Society for Surgery of the Hand http://www.assh.org

    Family Doctor—American Academy of Family Physicians http://familydoctor.org

    CANADIAN RESOURCES

    Canadian Centre for Occupational Health and Safety http://www.ccohs.ca

    Health Canada https://www.canada.ca/en/health-canada.html

    References

    Badalamente MA, Hurst LC, Benhaim P, Cohen BM. Efficacy and safety of collagenase Clostridium Histolyticum in the treatment of proximal interphalangeal joints in Dupuytren contracture: Combined analysis of 4 phase 3 clinical trials. J Hand Surg. 2015;5:975-983.

    Degreef I, Tejpar S, Sciot R, De Smet L. High-dosage Tamoxifen as neo adjuvant treatment in minimally invasive surgery for Dupuytren Disease in patients with strong pre disposition toward fibrosis. J Bone Joint Surg Am. 2014;96(8):655-662.

    Dupuytren disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114104/Dupuytren-disease. Updated February 8, 2017. Accessed September 7, 2017.

    Lanting R, Broekstra DC, Werker PMN, van den Heuvel ER. A systematic review and meta-analysis on the prevalence of Dupuytren Disease in the general population of Western countries. Plast Reconstr Surg. 2014;133(3):593-603.

    Rahr L, et al. Percutaneous needle fasciotomy for primary Dupuytren's contracture. J Hand Surg Eur Vol. 2011;36(7):548-552.

    Riester S, vanWijnen A, Rizzo M, Kakar S. Pathogenesis and treatment of Dupuytren disease. J Bone Joint Surg Reviews. 2014;2(4):e2.

    van Rijssen AL, et al. Five-year results of a randomized clinical trial on treatment in Dupuytren's disease: percutaneous needle fasciotomy versus limited fasciectomy. Plast Reconstr Surg. 2012 Feb;129(2):469-77.

    2/12/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114104/Dupuytren-disease: FDA approves Xiaflex for debilitating hand condition. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm199736.htm. Published February 2, 2010. Accessed September 23, 2014.

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