Dupuytren contracture

Overview

Dupuytren contracture is a condition that makes one or more fingers bend toward the palm of the hand. Over time, the affected fingers can't fully straighten. This happens because tough tissue under the skin of the palm slowly thickens and shortens into cords that pull the fingers down.

This condition often gets worse slowly, over years. It most often affects the ring finger and little finger, but any finger or thumb can be affected. The limited motion can make everyday activities difficult. These include putting on gloves, shaking hands and reaching into pockets.

There's no cure for Dupuytren contracture. But treatments can relieve symptoms and slow how quickly the condition gets worse.

Symptoms

In Dupuytren contracture, the first symptom typically is a thickening of the skin on the palm of your hand. Over the years, the skin on your palm may look puckered or dimpled, and a firm lump of tissue can form. This lump usually is painless. But sometimes it is painful.

Over time, the lump can form a hard cord that extends into the fingers. The finger is pulled into a bent position. Dupuytren contracture typically affects both hands.

When to see a doctor

See your healthcare professional if you notice:

• A lump in your palm that doesn't go away.
• A finger that starts to bend toward your palm.
• Trouble placing your hand flat on a table.
• Difficulty with everyday tasks, such as putting on gloves, shaking hands or reaching into pockets.

Causes

The cause of Dupuytren contracture is not known, but it tends to run in families.

Risk factors

People with certain diseases or health conditions may be more likely to develop Dupuytren contracture. Risk factors include:

• Age. Dupuytren contracture occurs most commonly after the age of 50.
• Sex. Men are much more likely to develop Dupuytren than are women. In men, symptoms may be worse and progress more quickly.
• Ancestry. People of Northern European descent are at higher risk of the disease.
• Family history. Dupuytren contracture often runs in families.
• Job. Some studies show a connection between Dupuytren contracture and people who use vibrating tools.
• Diabetes. People with diabetes have an increased risk of Dupuytren contracture.
• Tobacco and alcohol use. Smoking tobacco and drinking alcohol have both been linked with an increased risk of Dupuytren contracture in some studies.

Diagnosis

Most of the time, Dupuytren contracture can be diagnosed by simply looking at and feeling the hands. Other tests are rarely necessary.

During the exam, a healthcare professional:

• Compares both hands and looks for changes in the skin of the palms, such as dimpling or puckering.
• Gently presses on the hands and fingers to feel for firm bumps or tight cords of tissue.

A simple test called the tabletop test also may be used. You place your hand flat on a table. If your fingers cannot fully straighten to lie flat, treatment may be needed.

Treatment

If Dupuytren contracture is mild, causes no pain and doesn't limit your daily activities, you may not need treatment. Your healthcare professional may suggest simply watching to see if it gets worse. You also can check at home with the tabletop test. Place your hand flat on a table to see if your fingers can fully straighten.

If symptoms are mild, small changes can make daily tasks easier:

• Wrap handles with cushion tape so they are larger and easier to grip.
• Wear padded gloves when doing grasping tasks.

If treatment is needed, the goal is to loosen or remove the tight cords that pull your fingers toward your palm. But no treatment is a permanent cure. Over time, the cords may grow back and the fingers may bend again. The best treatment option depends on how serious your symptoms are and your overall health.

Needling

This procedure also is called needle aponeurotomy. A thin needle is inserted through numbed skin to puncture and break apart the cord of tissue that's pulling the finger down. The condition often comes back, but the procedure can be repeated.

The needling technique has several advantages. There are no large cuts to heal. It can be done on several fingers at the same time. It can be done in the office setting instead of the operating room. A disadvantage is that it can't be used in some places in the finger because it could damage a nerve or tendon.

Injections

• Steroids. Injections into the hard lump may help soften it and relieve pain, especially early in the disease.
• Collagenase, also called enzyme treatment. An injection of a special enzyme called collagenase weakens the cords. At a follow-up visit a few days later, your healthcare professional moves your hand to release or break the cords and straighten the finger. This can improve or even correct the condition for months to years.

Surgery

Surgery may be recommended for more serous symptoms. During surgery, the surgeon removes or releases the thickened tissue. If symptoms are very advanced, the skin also may be removed. A skin graft is used to cover the wound.

Surgery usually results in a more complete and longer lasting release than that provided by the needling or enzyme methods. But recovery takes longer.

Lifestyle and home remedies

If you have mild Dupuytren contracture, you can protect your hands by:

• Building up the handles of tools with padding, such as cushion tape, so you don't need to grip tightly.
• Wearing gloves while doing gripping tasks.

Preparing for an appointment

Your healthcare professional may refer you to a doctor who specializes in bones and joints, called an orthopedic surgeon.

What you can do

Before your visit, think about and be ready to talk about the following with your healthcare professional:

• Whether anyone in your family has the condition.
• Treatments you've tried so far, including how they worked.
• What medicines, vitamins or supplements you take regularly.

What to expect from your doctor

You may be asked:

• When did your symptoms start?
• Are they getting worse?
• Do you have pain in your hand?
• How does the condition affect your daily activities, such as dressing, working or using your hands?