Dupuytren’s contracture

A leading cause for progressively curling-in fingers

Dr Kim Latendresse MD FRCSC FRACS, Orthopaedic Surgeon, Surgery of the Hand, Wrist and Elbow


Are your fingers slowly curling in? Do you have lumps in your hand or fingers? Have you noticed firm strings of tissue that feel like tendons in your hand? Are they preventing you from straightening your hand out and laying it out flat? Are your fingers getting in the way because of this?

Dupuytren’s contracture is a common cause for this problem. This is caused by a progressive thickening of the tissue under the skin of your hand, called the palmar aponeurosis. This tissue normally assists in keeping the skin in the palm of your hand in place, allowing you to hold on to objects. When you have Dupuytren’s contracture, parts of this tissue progressively thicken, resulting in the appearance of lumps (nodules) and strings of tissue (cords). With increasing thickening, the tissue shortens and pulls the fingers in, gradually curling your fingers in.

Consulting a hand surgeon may help. Hand surgeons are trained in recognising the condition, and can discuss the recommended treatment options with you, helping you decide on the best course of action. Surgeons at the Sunshine Coast Centre for Orthopaedics are experienced in the treatment of this disorder and are available to treat you.

Remember that the information contained on this site is intended to serve as a guide only, and does not replace an evaluation by an expert to ensure you receive the correct diagnosis and advice tailored to your own circumstances.

Dupuytrens Contracture


Causes

In most cases, there is a genetic (inherited) pre-disposition to developing the disease. It often runs in families, and most people who develop it are from Northern European extraction.


Manifestations

There is usually a history of slowly developing cords and/or nodules in the hand. This may involve both hands, and any finger, including the thumb, can be affected. The condition is rarely painful, but as the fingers progressively curl in, it becomes increasingly difficult to perform activites which require the hand to be flat out, such as shaking hands, placing the hand in a pocket, or putting on gloves. Some people have difficulty shaving, or doing up their hair, as a result of this. Left untreated, the finger may progressively remain permanently curled-in over time.


Treatment

Although there are reliable treatments available, there is no known cure for Dupuytren’s contracture. Over time, it is expected that the curling-in will worsen. In some people, this may occur rather quickly over the course of a few years, whilst in others in could take decades. Most people presenting for treatment will have noted the presence of lumps and cords for 10 years or so. The table-top test is a good clue to help determine if you may benefit from treatment. This consists of trying to lay the hand flat out on a hard surface. If you are unable to do so, this may be an indication that you may benefit from treatment. Also, you may benefit from treatment if you notice that your “PIP” joint (the second knuckle from your nail) shows any signs of curling in.


Options

There are several options for treatment of Dupuytren’s contracture. In many early cases, observation is the only recommended treatment. It is best to obtain an expert opinion to make sure this is a good option. Sometimes, if a nodule (lump) is painful, an injection of cortisone may help relieve the pain. Trying to forcefully stretch the finger out, using a brace for example, has in some cases resulted in an acceleration of the disease!

Some people may benefit from releasing the cord through a very small skin incision. This is usually done under local anaesthetic and is called a percutaneous cordotomy. Although the recovery from this procedure is minimal, it does not remove the cord and it has variable recurrence rates.

Another option is called a fascietomy. This is usually done in the operating theatre, and consists of removing the cords and nodules causing the contracture. Depending on the degree to which the finger is curled in, the skin may have become too tight over time to allow the finger to come out straight, or the skin may be severely thinned out. This may require the skin to be managed by skin flaps called z-plasties (small cuts to shift the skin around) or by a skin graft (taking healthy skin from another area in your body to cover a defect.) Following this type of surgery, your surgeon may advise you to see a hand therapist to assist with your recovery.

A newer treatment alternative is an injection of enzymes called collagenase, which destroys a portion of the cord and allows the finger to recover and come out straight again. This is usually done in the surgeon’s rooms, and may be another option to consider.


Results

Most people are very happy with the results of treatment. The amount of correction achieved depends on many factors, including the severity of the curling-in, and the presence or absence of underlying arthritis of the affected joints. There are also risks associated with any procedure, and some may leave you worse off, although this is rare. Over time, the condition may come back (recur) in an area that was previously treated, or progress in other fingers. The decision to undergo a specific treatment should be taken after a frank discussion of the advantages, alternatives, and risks of a procedure with a qualified surgeon who has experience in the treatment of this condition.


For further information, please follow this link to the American Academy of Orthopaedic Surgeons’ Information on Dupuytren’s contracture.