by Alan R

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

A risk factor is something that increases your chance of getting a disease or condition.
  • Age: 40 and over
  • Sex: male
  • A parent with Dupuytrens contracture
  • Hand trauma
  • Manual labor
  • Vibration exposure at work
  • Alcohol abuse
  • Epilepsy
  • Use of certain anticonvulsant medications for epilepsy
  • Liver disease
  • Smoking
  • Diabetes

Symptoms

At first, symptoms of finger curling are mild, but they may become progressively worse. 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

The doctor will ask about your symptoms and medical history. A hand examination will be done. In some cases a hand ultrasound, CT or MRI may be taken.

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

Exercise Therapy After Surgery

This is usually needed to restore full range of motion and use of the repaired finger(s).
Dupuytrens contracture can recur after surgery.

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 medicine that can be injected is called collagenase clostridium histolyticum. This biologic drug breaks down the thickened tissue in the hand.
If you are diagnosed with Dupuytrens contracture, follow your doctor's instructions .
If you are diagnosed with Dupuytrens contracture, follow your doctor's instructions .

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 Academy of Family Physicians http://familydoctor.org

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

CANADIAN RESOURCES

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

Health Canada http://www.hc-sc.gc.ca

References

Dupuytren disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated January 17, 2012. Accessed October 23, 2012.

Rahr L, et al. Percutaneous needle fasciotomy for primary Dupuytren's contracture. J Hand Surg Eur Vol . 2011 Sep;36(7):548-52.

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's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : 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 February 12, 2010.

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