Dupuytren’s Contracture is the name given to a condition where the fibrous tissue layer underneath the skin of the palm and fingers thickens. This condition is painless, however, the thickening of the fibrous tissue creates a thick cord under the skin and can cause the fingers to curl or flex. This condition is something develops over a long period of time, usually years, and is more common in men than women. Dupuytren’s contracture most often affects the ring finger and the pinky, and most often is seen in older men. There are a number of treatments available to slow the process of the condition and relieve symptoms.
Causes of Dupuytren’s Contracture
Doctors are unsure what causes Dupuytren’s contracture to occur, but it is known that it is not due to injury or excessive hand use.
Risk Factors for Dupuytren’s Contracture
There are a number of factors that put patients at greater risk of experiencing this condition. They include the following:
- Hereditary: It is often seen to run in families
- Age: Most cases of Dupuytren’s Contracture occurs after the age of 50
- Sex: Men are most at risk of developing this disease and quite often are seen to have more severe symptoms than women suffering from Dupuytren’s
- Tobacco and Alcohol: A trend has been seen that those who smoke frequently and regularly consume alcohol are among the high risk factors for Dupuytren’s, possibly due to microscopic changes in blood vessels that occur with smoking
- Ancestry: This condition is seen most often in people of Northern European descent, although is it not clear why
- Existing medical conditions: Those who suffer with medical conditions such as diabetes are at a high risk for developing this condition
Dupuytren’s Contracture progresses gradually, usually over several years. The condition is first manifested in thickening of the skin on the palm of the hand. With development over time, the skin on the palm may appear dimpled. A knot of tissue (or several) may also develop on the palm, which at first are tender to the touch, but not usually painful. Over time, the knots of tissue become less sensitive. As Dupuytren’s Contracture develops, the tissue underneath the skin of the palms creates cords, going from the bottom of the palm, extending all the way up to the fingers. This is when the fingers can be pulled towards the palm, to differing extents for each patient. The ring finger and the pinky are the fingers most commonly affected, but the other fingers can be involved in some cases. It is more common for the middle finger to be involved than the thumb and the index finger however.
Dupuytren’s Contracture can occur in both hands at the same time, but is usually more severe in one hand than the other. Once the curling of the fingers occurs, this is when normal everyday tasks can be a challenge. Things like grasping large items, putting on gloves and putting a hand in the pocket can be complex. The curling of the fingers makes it very difficult to open the hand fully, though since the index finger and the thumb are rarely affected; writing is usually not an issue for patients.
Diagnosis of Dupuytren’s Contracture
When a doctor’s appointment is made to look at a suspected case of Dupuytren’s Contracture, a doctor will examine various parts of the hand to make a knowledgeable diagnosis and inform him or herself as to the severity of the condition.
The doctor will most often:
- Test the feeling and sensitivity in the thumb and fingers
- Test a patients gripping ability
- Record the exact locations of a patients nodules and fibrous tissue bands on the palm
- Using a special device, measure the level of contracture in the fingers
- Measure the range of motion in the fingers to determine the effect on the patients flexion
- The doctor will return to his or her measurements and results throughout treatment to test whether the condition is developing or not.
Treatment for Dupuytren’s Contracture
Following a doctor’s appointment, he or she may recommend different methods of treatment depending on the progression and severity of a patient’s case.
If the Dupuytren’s Contracture is mild, slow in progress, with no pain and hardly impacts the patient’s ability to use their hands for everyday tasks, a doctor may not recommend any specific treatment. With this line of action, a patient can wait and watch the progression of this condition. If this is the case, a home tabletop test can be carried out to measure the progression. This technique involves placing your palm face down on a table and seeing how far the hand can be straightened out. The further along in the development of the condition, the harder it will be for the fingers to lay flat on the surface of the table.
Treatment for Dupuytren’s Contracture involves the removal or breakdown of the cords that have developed and caused the fingers to curl. This can be done through several different methods, the choice of which depends on the severity of symptoms and other contributing health factors.
- One of the non-surgical procedures used to treat this condition is called needling. This technique uses a needle which is inserted through the skin to puncture and break apart the cord of tissue that contracts the finger.
- This process is rarely a permanent solution to the issue as contractures can recur, but the process can be repeated with each occurrence.
- These are injections that go directly into the cord in a patients palm to weaken and soften it. Once this is done, the doctor can later manipulate the hand in order to break the cord completely and straighten out the hand.
- This procedure is done in the doctor’s office, usually in conjunction with a local anesthetic injection to first numb the hand, as the procedure can be initially painful.
- The benefit of this treatment is that so far it has been seen to withhold recurrences of contractures, and requires less invasive treatment than surgery.
For patients who have been suffering from Dupuytren’s Contracture for some time, it may be advantageous to explore the option of surgery.
This procedure involves opening up the palm of the hand and removing the tissue in the palm affected by the disease. In severe cases, surgeons may cut out all the tissue surrounding the contracture and likely to be affected by it in the future, including some of the skin from the surface of the palm. In this case, a surgeon will need to perform a skin graft. In both of these methods of surgery, a patient will require post-operative physical therapy to fully recover the hand and fingers. In the second case where the skin graft is requires, physical therapy will be more intensive and will likely require months of recovery.
If you believe you may be suffering from Dupuytren’s Contracture and would like a firm diagnosis, please contact your doctor to assess the progression of the disease and seek out the best treatment option for your case.
If you are ready to choose a team of hand, wrist and elbow orthopedic and sports medicine specialists that offer state-of-the-art treatment and highly personalized care, contact the OSMI office or call 817-529-1900 today.