Dupuytren’s contracture is a condition that causes nodules, or knots, to build up underneath the skin of your fingers and palms. It can cause your fingers to become stuck in place. It most commonly affects the ring and little fingers and causes the proximal and middle joints, which are those closest to your palm, to become bent and difficult to straighten. Treatment varies depending on the severity of the nodules.
Dupuytren’s contracture usually progresses very slowly. Often, the first symptom is a thickened area on the palm of your hand. It may be described as a lump or nodule and include small pits on your palm. The lump is often firm to the touch, but it’s not painful.
Over time, thick cords of tissue extend from the lump. They usually connect to your ring or pinky fingers, but they can extend to any finger. These cords eventually tighten, and your fingers can become pulled into your palm.
The condition can occur in both hands, but usually one hand is more severely affected than the other. Dupuytren’s contracture makes it difficult to grasp large objects, wash your hands, or shake hands.
Causes and Risk Factors
The cause of this disease is unknown, but your risk of developing the condition increases if you:
- are male
- are between 40 and 60 years of age
- are of Northern European descent
- have a family history of the condition
- smoke or drink alcohol
- have diabetes
Overuse of your hands, such as from working in a job that requires repetitive hand motions, and hand injuries don’t increase your risk of developing this condition.
Your doctor will examine your hands for lumps or nodules. Your doctor will test your grip, your ability to pinch, and the feeling in your thumb and fingers.
They’ll also perform the tabletop test, which requires you to put the palm of your hand flat on a table. If you’re able to do this, you don’t have the condition.
Your doctor may take measurements and record the location and amount of contracture. They will refer to these measurements at future appointments to see how quickly the condition is progressing.
There’s no cure for Dupuytren’s contracture, but there are treatments available. You may not need any treatment until you’re unable to use your hands for everyday tasks. Nonsurgical treatments are available, including steroid injection, which can prevent progression of the contracture, and splinting.
In more severe or progressed cases, your doctor may recommend surgery. Surgical treatment involves breaking up the cords that are pulling your fingers in. The severity of your condition will determine the best course of treatment:
Needling involves using a needle to break the cords apart. The contracture often comes back, but the procedure can be repeated.
The advantages are that needling can be done multiple times and it has very short recovery time. The disadvantage is that it can’t be used on every contracture because the needle could damage nearby nerves.
Xiaflex, an injectable collagenase injection, weakens the cords. Your doctor will manipulate your hand to try to break up the cord the day after the injections are given. This is an outpatient procedure with a short recovery time.
The disadvantages are that it can be used on only one joint each time and there’s a high recurrence of the fibrous bands. The treatments must be at least one month apart.
Surgery removes the cord tissue, but it may need to be done at a later stage when the cord tissue is identifiable. On occasion, it may be hard to remove the cord without removing the attached skin.
This is a more permanent solution to the contracture. The disadvantages of surgery are that it has a long recovery period and requires physical therapy to return full hand movement and functionality. On rare occasions, skin tissue may also be removed during the surgery, which requires a skin graft to cover the area.
Some things you can do at home to ease your pain and other symptoms include:
- stretching your fingers away from your palm
- relaxing the contracture using massage and heat
- protecting your hands by using gloves and avoiding gripping tightly when handling equipment
Dupuytren’s contracture isn’t life-threatening. You can work with your doctor to determine which treatment options will work best for you. Learning how to incorporate at-home treatments can help you manage your contracture.