Dupuytrens Contracture
Dupuytren’s contracture is thickening of the fibrous tissue layer under the skin of palms, fingers, and hands
which leads to curving of the finger. It is caused due to the excessive production of collagen which gets
deposited under the skin. Hereditary factors, excessive alcohol consumption, diabetes, seizures, and increased
age may increase the risk of developing the condition. It commonly occurs in the ring finger and little finger.
Occasionally the middle finger is affected but the thumb and index finger are rarely affected. Dupuytren’s contracture
is a condition that usually progresses slowly over many years and is not painful. However, some cases progress rapidly
and may be painful to the patient..
The most commonly observed symptoms of Dupuytren’s contracture are lumps or nodules in the palm, difficulty in straightening the finger, and contracture of
the nodules which forms tough bands under the skin.
The cause of Dupuytren’s contracture is unknown. However, there are certain risk factors that may increase your chance of developing the condition.
These can include the following:
Age: It occurs more frequently around ages 40.
Social Habits: Smoking and drinking alcohol may increase your risk of developing the condition
Medical Conditions: Patients with diabetes, alcoholism, cirrhosis of the liver, and seizure disorders appear to be at increased risk of
developing the condition.
Gender: The condition is more common in males than females.
Heredity: The condition tends to run in families.
Ancestry: Most commonly affected are northern Europeans and people of Scandinavian descent.
Hand and wrist conditions should be evaluated by an orthopaedic hand surgeon for proper diagnosis and treatment. Your surgeon will collect
medical history and perform physical examination. Dupuytren’s contracture is diagnosed based on the history and physical and without any special testing
required.
Conservative Treatment Options
You may not need treatment for Dupuytren’s contracture if the condition is not affecting your ability to perform daily activities. However, if you are
experiencing pain or if having difficulty using your hands for everyday activities, your surgeon will recommend conservative treatment options to
treat your condition. Treatment options will vary depending on the severity of the condition. The conservative approaches include:
Heat: Applying heat to the palms of the hand prior to massage or exercise can help to loosen the tissues.
Massage: Gently massage the thickened tissues of the palm.
Exercises: Stretching exercises such as bending the fingers away from the palm may be useful.
Injections: Steroid injections in the palm may be done to relieve local inflammation.
Needle Aponeurotomy: This procedure involves inserting a small needle into the thickened palm tissue and manipulating it to loosen
and break up the contracting tissue. Ultrasound may be used to guide the needle to avoid hitting nerves or tendons.
Collagenase Injection: An enzymatic drug that breaks down collagen can be injected into the corded tissue to soften and
weaken the contracture. The physician then manipulates the tissue manually to break up the tissue.
Surgical Procedure
If conservative treatment options fail to resolve the condition and symptoms persist for 6 months or more and your quality of life is adversely affected,
your surgeon may recommend you undergo a surgical procedure to open the tendon sheath and allow more room for tendon movement.
This surgery is usually performed in an operating room under local or regional anaesthesia on an outpatient basis as day surgery.
Your surgeon makes a small incision to the affected palm area. The surgeon then removes the thickened fibrous tissue causing the contracture. The
incision is then closed with sutures and covered with a sterile dressing.
Complications can be medical (general) or specific to hand surgery. Medical complications include those of the anaesthetic and your general well being.
Some of the complications associated with the surgery include:
Infection
Nerve damage causing weakness, paralysis, or loss of feeling in the hand area
Injury to the arteries of the fingers/hand
Recurrence
Allergic reactions to medications
Blood loss requiring blood transfusions
Heart conditions
Serious medical problems can lead to on-going health concerns, prolonged hospitalization, or rarely disease
This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.
