Hand and Wrist

Dupuytren's Contracture

Description

Dupuytren's contracture is a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. It is a painless condition and not dangerous, however, the thickening and tightening (contracture) of this fibrous tissue can cause the fingers to curl (flex). Dupuytren's contracture usually progresses very slowly. It may not become troublesome for years, and may never advance beyond lumps in the palm. There is currently no treatment to stop, cure or prevent Dupuytren's contracture.

Symptoms

Symptoms of Dupuytren's contracture usually occur very gradually, and may include:

• Nodules—One or more small, tender lumps (nodules) form in the palm. Any tenderness usually goes away over time.
• Bands of tissue—These nodules may thicken and contract, forming tough bands of tissue under the skin.
• Curled fingers—One or more fingers may bend or flex toward the palm. The ring and little fingers are most commonly affected, but any or all fingers can be involved.

Causes

Dupuytren's contracture is a hereditary condition that occurs most commonly in families of Northern European (English, Irish, Scottish, French, Dutch) or Scandinavian (Swedish, Norwegian, Finnish) ancestry. Other factors associated with a greater risk of developing Dupuytren's contracture include certain medical conditions such as diabetes or seizures, and alcohol consumption. The frequency of occurrence increases with age.

Nonsurgical Treatment

Your doctor may recommend nonsurgical treatment to provide relief, however splinting does not prevent increased contracture in the finger and forceful stretching of the contracted finger rarely helps.

• Steroid injection—In rare cases, an injection of corticosteroid may be used if a lump is painful. Although this powerful anti-inflammatory medication may help relieve the pain, it is rarely curative.
• Breakage of the cord—This may be accomplished with enzyme injections and manipulation in the office, in more localized cases.

Surgery

When contracture starts to progress out into the finger, or when you can no longer place your hand flat on a table, your orthopaedic surgeon may recommend surgery. During this procedure, the thickened bands are divided or removed to help restore finger motion. In some cases, the wound is left open and allowed to heal gradually. Skin grafting may be needed, but this is rare.

With any surgery there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.