What is Dupuytren’s contracture?
Dupuytren’s contracture is a condition that causes nodules, or knots, to form 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. However, it can involve any finger. It causes the proximal and middle joints — those closest to your palms — to become bent and difficult to straighten. Treatment varies depending on the severity of the nodules.
Dupuytren’s contracture usually progresses slowly. Often the first symptom is a thickened area on the palm of your hand. You could describe it as a lump or nodule that includes 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 affected than the other. Dupuytren’s contracture makes it difficult to grasp large objects, wash your hands, or shake hands.
The cause of this disease is unknown. But your risk of developing it 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 doing 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 also test your grip, your ability to pinch, and the feeling in your thumb and fingers.
They’ll also perform the tabletop test. This requires you to put the palm of your hand flat on a table. It’s unlikely you have the condition if you can do this.
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 can’t use your hands for everyday tasks. Nonsurgical treatments are available. However, in more severe or progressed cases, your doctor may recommend surgery.
Treatment options include:
Needling involves using a needle to break the cords apart. This procedure can also be repeated if the contracture often comes back.
The advantages of needling are that it can be done multiple times and has a very short recovery period. The disadvantage is that it can’t be used on every contracture because the needle could damage nearby nerves.
Xiaflex is an injectable collagenase injection that weakens the cords. Your doctor will manipulate your hand to try to break up the cord the day after you get the injections. 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 the treatments must be at least one month apart. There’s also a high recurrence of the fibrous bands.
Surgery removes the cord tissue. You may not need surgery until a later stage when the cord tissue can be identified. Sometimes it may be hard to remove the cord without removing the attached skin. However, with careful surgical dissection, you doctor can usually prevent this.
Surgery is a permanent solution. The disadvantages are that it has a longer recovery time and often requires physical therapy to regain full function of your hand. And if your doctor removes tissue during the surgery, you will need a skin graft to cover the area. But this is rare.
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
- 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. Learning how to incorporate treatment can help you manage your contracture.