Dupuytren contracture (Dupuytren’s disease) affects the hands and fingers. It causes fingers and occasionally the thumb to bend into the palm of the hand. This occurs due to the thickening of the fascial tissue under the palm which pulls the affected finger towards the palm.
This condition is more common in people of North European descent. It is not common among Asian. It can affect both sexes, but affects men more than women. The condition usually occurs during later life (men over 50 and women over 60), although cases have been reported in children too.
The exact cause of Dupuytren’s contracture is unknown, but it’s thought to be related to your genes, as it often runs in families. Other factors such as diabetes, smoking and certain medications (epilepsy drugs) may activate the condition.
Early symptoms are the appearance of a small nodule from the tissue thickening in one small area. This nodule feels like a small, hard lump about 0.5-1cm under the skin of the palm. The nodule can be tender initially, but this usually passes. Sometimes, unusual dimpling (called pitting) is also seen in the palm. More nodules may then develop. The nodules are non-cancerous (benign). Over time, the nodules can join and form cords of hard tissue. These cords can then shorten (contract) and, if the cords run along a finger or thumb, they can pull it, so it becomes bent towards the palm.
All fingers and thumb can be affected, but the most common sites involve the ring finger and little finger. It can happen in one or both hands.
These contractures are often mild and painless, but they can get steadily worse over time. This can make it difficult to perform activities such as swimming, playing a guitar or shaking someone’s hand.
Similar thickening can occurs in other sites.
- Garrod’s pads – nodules that develop on the back of the knuckles on the fingers
- Ledderhose’s disease (plantar fibromatosis) – nodules and contractures that affect the plantar surface of the foot
- Peyronie’s disease – where the tissue of the penis is affected, causing it to become abnormally curved
These conditions can occur on their own, but some people are affected by several of them at the same time.
Treating Dupuytren’s contracture
Majority cases with nodules and pitting (or even mild bending of fingers) are mild and do not interfere with the hand function. They don’t need treatment.
Treatment may be helpful if the condition is interfering with the normal functioning of your hand.
Non-surgical treatments include injections with an enzyme called collagenase. When injected into the cord in the palm, it can soften and weaken it — allowing the doctor to later manipulate your finger in an attempt to break the cord and straighten your finger.
Alternatively, a minor procedure that involves using a needle to cut the contracted cord of tissue (needle fasciotomy) followed by manipulation to straighten the finger may be used in the early stages.
In more severe cases, surgery is required to restore the affected hand function. The two most common surgical techniques are:
- open fasciotomy – where the shortened connective tissue is cut to relieve tension
- fasciectomy –where the shortened connective tissue is removed partially or completely.
Surgery for Dupuytren’s contracture can’t always fully straighten the affected finger or thumb, and the contracture can recur after surgery. If a contracture does recur, further surgery may be possible.
It is best to remember that having surgery to remove the first nodule that appears won’t stop the condition from progressing nor will it stop the condition occurring elsewhere in the palm. It’s usually best to avoid surgery until a contracture develops that interferes with use of the hand.