Dupuytren Contracture

Dupuytren contracture is a painless thickening and tightening (contracture) of tissue beneath the skin on the palm of the hand and fingers.

Causes

While the cause is unknown, you are more likely to develop this condition if you have a family history of it. It does not seem to be caused by occupation or from trauma.

The condition is more common after age 40, and men are affected more often than women. Risk factors include alcohol use, diabetes and smoking.

Symptoms

One or both hands may be affected. The ring finger is affected most often, followed by the little, middle and index fingers.

A small, nodule or lump develops in the tissue below the skin on the palm side of the hand. Over time, it thickens into a cord-like band. Usually, there is no pain. In rare cases, the tendons or joints become inflamed and painful. Other possible symptoms are itching, pressure, burning, or tension.

As time passes, it becomes difficult to extend or straighten the fingers. In severe cases, straightening them is impossible.

Exams and Tests

The health care provider will examine your hands. Diagnosis can usually be made from the typical signs of the condition. Other tests are rarely needed.

Treatment

If the condition is not severe, your provider may recommend exercises, warm water baths, stretching or splints.

Your provider may recommend treatment that involves injecting medicine or a substance into the scarred or fibrous tissue:

  • Corticosteroid medicine relieves inflammation and pain. It also works by not allowing thickening of the tissue to get worse. In some cases, it heals the tissue completely. Several treatments are usually needed.
  • Collagenase is a substance known as an enzyme. It is injected into the thickened tissue to break it down. This treatment may be just as effective as surgery.

Surgery may be done to remove the affected tissue and is usually recommended in severe cases when the finger can no longer be extended. Physical therapy exercises after surgery help the hand recover normal movement.

A procedure is called aponeurotomy may be recommended. This involves inserting a small needle into the affected area to divide and cut the thickened bands of tissue. There is usually little pain afterward, and healing is faster than surgery.

Radiation is another treatment option. It is used for mild cases of contracture, when the tissue is not so thick. Radiation therapy may stop or slow down thickening of the tissue, and it is usually done only one time.

Talk to your provider about the risks and benefits of the different kinds of treatments.

Outlook (Prognosis)

The disorder progresses at an unpredictable rate. Surgery can usually restore normal movement to the fingers. The disease can recur within 10 years after surgery in up to half of cases.

Possible Complications

Worsening of the contracture may result in deformity and loss of function of the hand.

There is a risk of injury to blood vessels and nerves during surgery or aponeurotomy.

When to Contact a Medical Professional

Call your provider if you have symptoms of this disorder.

Also call if you lose feeling in your finger or if you finger tips feel cold and turn blue.

Prevention

Awareness of risk factors may allow early detection and treatment.