Dupuytren's Contracture

What it is

Dupuytren's disease affects the fascia, a fibrous layer beneath the skin of the palm. The fascia thickens into nodules and cords. Cords look and feel like tendons, but they are not attached to a muscle and do not move. Over time they can pull one or more fingers, most often the ring and small fingers, into a bent position.

What causes it

Dupuytren's is hereditary, so family history and ancestry play a role. It is more common in men, after age 40, and in people of Northern European descent, and is associated with smoking, diabetes, and alcohol use. There is no evidence that hand use or particular jobs cause it.

Symptoms

• Firm lumps or pits in the palm, usually painless
• Cords running from the palm into the fingers
• Difficulty laying the hand flat, putting on gloves, shaking hands, or reaching into a pocket

How the disease progresses is hard to predict. Some people only ever have small lumps.

Treatment

A lump in the palm does not by itself need treatment, and mild cases can simply be watched. Splinting and stretching do not prevent progression. Treatment is usually considered once you can no longer lay your hand flat on a table, and the best option depends on the stage and pattern of the disease and the joints involved.

Needle aponeurotomy: an office procedure under local anesthesia in which a needle is used to cut the cord, and the finger is then gently straightened. Recovery takes only days. Because the cord is not removed, roughly one in three patients sees it return.

Collagenase injection: a two-step office treatment. An enzyme is injected to dissolve the cord, and a day or a few days later the finger is numbed and straightened. Swelling and bruising are common at first, and recovery takes days to a few weeks. As with the needle procedure, about one in three cords return.

Surgery: a fasciotomy cuts the cord through small incisions, while a fasciectomy removes as much of the diseased tissue as possible through longer incisions. Both are same-day outpatient procedures. Surgery may be more effective, but recovery is longer, usually about six weeks for a fasciectomy.

Recovery

Splinting and hand therapy are often used after any treatment. Starting exercises right away, and working on making a fist as well as straightening the finger, gives the best result. Full straightening is not always possible, and the improvement may not last forever. Dupuytren's cannot be cured, so it can return or appear in other fingers, and it can be treated again if needed.