Dupuytren's Contracture
What Is Dupuytren's Contracture?
Dupuytren's contracture is a progressive hand condition affecting the fascia of the palm and fingers. The fascia is a specialized network of fibrous tissue that binds individual tissue layers together, similar to the glue that holds plywood layers in place. This condition develops when normal fascia gradually thickens and contracts, eventually causing the fingers to bend downward toward the palm.
The exact cause of Dupuytren's contracture is unknown, though genetic factors likely play a significant role. The condition shows a strong association with men of Northern European descent. Research has identified specialized cells that may control the growth of Dupuytren's tissue, suggesting an active metabolic process at the cellular level causes normal fascia to become diseased. Current research focuses on finding medications that could block this cellular activity, though no preventative measures are currently available.
The first sign of Dupuytren's contracture is typically the appearance of small nodules in the palm of the hand that feel like hard lumps. Over several months or years, these nodules can coalesce and grow together to form long bands called cords. As the cords become more diseased and contracted, they pull the fingers downward, resulting in an inability to fully straighten the affected fingers. The ring finger and pinky are most commonly affected, though the condition can impact all digits in some individuals. While Dupuytren's nodules and cords are usually not painful, the progressive loss of motion can significantly interfere with daily activities and hand function.
Dupuytren's contracture is generally a benign condition that does not spread to other areas of the body. However, some patients may develop similar cords and nodules on the soles of their feet. The condition can rarely be associated with other medical conditions such as diabetes and alcoholism.
Nonsurgical Treatments
While surgery is the most effective treatment for Dupuytren's contracture, some nonsurgical approaches may be considered in early stages or less severe cases. Our doctors can evaluate your condition and discuss all available treatment options.
Lifestyle Modifications
Monitoring the progression of the condition is important. Patients should track changes in hand function and finger flexibility. While no lifestyle modifications can prevent or reverse Dupuytren's contracture, maintaining hand flexibility through gentle stretching may help preserve function in the early stages.
Medications & Injections
Injectable enzyme treatments may be considered in certain cases to break down the contracted cords. These treatments are typically used for specific presentations of the condition and must be administered by experienced practitioners. The effectiveness varies, and the condition may recur after treatment.
Physical & Occupational Therapy
Hand therapy can help maintain flexibility and function in the affected hand. Therapists may provide exercises to preserve range of motion and techniques to adapt daily activities to work around hand limitations. Following any treatment, intensive hand therapy is often necessary to regain motion and strength.
Supportive & Assistive Devices
Splinting may be recommended in some cases to help maintain finger extension, though its effectiveness in preventing disease progression is limited. Adaptive devices and tools can help compensate for reduced hand function in daily activities.
Surgical Treatments
Surgery is the most effective treatment for Dupuytren's contracture. The procedure is typically postponed until the finger loses approximately 20 to 30 degrees of motion and patients can no longer place their hand flat on a tabletop. The right surgical approach depends on the extent of the disease, which fingers are affected, and whether this is a primary or recurrent case.
Fasciectomy
This procedure involves surgically removing the diseased fascia from the palm and fingers. The surgeon makes a zigzag incision in the skin overlying the diseased cord. The tendons, nerves, and blood vessels are carefully identified and protected while the diseased tissue is meticulously removed. Any surrounding fascia that appears obviously diseased is also removed. Surgery can be very detailed and precise to protect delicate neurovascular structures while removing all diseased tissue. Surgery is limited to removing only the diseased tissue, as removing normal fascia has not been shown to prevent disease progression.
Revision Surgery
Dupuytren's contracture can recur in approximately 30 percent of patients within five years of surgery, though it usually does not return to the same severity that initially required treatment. If the disease progresses to require additional surgery, not only is the diseased fascia removed, but in some cases the overlying skin must be surgically removed and replaced with a skin graft to reduce the risk of further recurrence.
Recovery following surgery is highly dependent on individual circumstances and the extent of the procedure. Surgery can be extensive and requires several weeks to a few months of postoperative recovery. Patients typically require hand therapy, including specialized splints and supervised exercises to regain motion and strength. Most patients can resume normal daily activities within a few weeks, though vigorous activities such as sports may require several months of recovery.