What Is Dupuytren's Contracture? What Cause Dupuytren's Contracture?

Editor's Choice
Main Category: Bones / Orthopedics
Also Included In: Dermatology
Article Date: 16 Nov 2009 - 6:00 PDT


Dupuytren's contracture, also referred to as morbus Dupuytren, Dupuytren's disease, or palmar fibromatosis occurs when fibrous tissue in the hand thickens and shortens, specifically the palm of the hand. The fingers bend towards the hand and cannot be completely stretched out (fully extended). The fourth and fifth digits (ring finger and small finger) are most commonly affected.

Meaning of contracture - abnormal shortening of tissue, making it highly resistant to stretching.

Dupuytren's contracture is named after the French surgeon, Baron Guillaume Dupuytren, who first described the condition and how to operate in 1834.

Samuel Beckett, Ronald Reagan, Misha Dichter (pianist) and Margaret Thatcher are examples of some notable sufferers of Dupuytren's contracture.

The condition is caused by underlying contractures of the palmar aponeurosis (palmar fascia) - the thin, tough layer of fibrous tissue between the skin of the palm and the underlying flexor tendons of the fingers.

Dupuytren's contracture is a common problem which affects middle aged people. In some cases, however, individuals in their twenties may be affected. In a considerable number of cases the condition runs in families.

People with diabetes, alcoholics with cirrhosis of the liver, and individuals with epilepsy have a higher risk of developing the condition. Experts disagree whether the link is with epilepsy itself, or the medications people take for it.

After the age of 40 men have a higher risk of developing the condition. After the age of 80 the risk is about the same. Caucasians have a higher risk of developing the condition compared to people of other ancestries.

What are the signs and symptoms of Dupuytren's contracture?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor notice. For example, pain may be a symptom while a rash may be a sign.

Signs and symptoms develop gradually:

• The sufferer may notice a tender lump in the palm. There may be pain at first, but this usually goes away.
• Tough bands of tissue may develop, and gradually reduce mobility. The bands may appear similar to a small callus (an especially hard area of skin).
• Unusual dimples or lumps may appear in the palm. Skin puckering may occur over the lumps.
• The finger(s) cannot be fully straightened out. Some people see this as a deformity and become distressed.
• Toes may be affected, but this is very rare.
• In about half of all cases, both hands are affected.

The condition is not usually painful. The main problem for the sufferer is not being able to use that finger(s) as well as he/she used to. The contracture may be mild to severe.

What are the causes of Dupuytren's contracture?

Nobody knows what the specific cause of Dupuytren's contracture is. There are, however, some risk factors which are linked to the condition:

• Genes - people can inherit Dupuytren's contracture from a parent. 60% to 70% of those afflicted have a genetic predisposition.
• Age and gender - middle aged people have a much higher risk of developing the condition compared to younger individuals. From middle age up to about 80 years the majority of patients are male, after the age of 80 years susceptibility is about equal.
• Being Caucasian - white European people have a higher risk of developing Dupuytren's contracture. Some people refer to it as the Viking disease.
• Alcohol abuse - alcoholics, especially those with cirrhosis of the liver, have a higher risk.
• Smoking - there is a link between heavy regular smoking and Dupuytren's contracture risk.
• Diabetes - patients with diabetes, especially those who control their condition poorly, have a higher risk of developing Dupuytren's contracture, compared to others.
• Epilepsy - the percentage of people with epilepsy who also develop Dupuytren's contracture is much higher than among people without epilepsy. However, whether the link is with epilepsy itself or drugs used to treat it is unknown.

How is Dupuytren's contracture diagnosed?

The doctor will examine the hand(s) for signs, such as dimples, pitted marks, thickened skin, bent fingers and lumps (nodules).

Tabletop test - patients place their hand flat on a table top, palm down. If they cannot flatten their hand they probably have the condition.

What are the treatment options for Dupuytren's contracture?

In a significant number of cases no treatment is necessary - if the contracture is mild and does not progress at a rate that might seriously undermine the individual's ability to perform everyday chores. Even with treatment and surgery there is no way to permanently cure the condition, or stop its progression.

Most doctors agree that surgical intervention is required when the joint contracture is over 30 degrees.

Surgery - the surgical removal of fibrous tissue (excision) may help provide better mobility of the affected fingers. However, this is not a cure, and the condition will continue to progress. If there is material wrapped around arteries and nerves, there is a risk of nerve or arterial injury. In the majority of cases surgery is carried out under local anesthesia on an outpatient bases.

• Fasciotomy - connective tissue is cut to remove tension. With needle fasciotomythe surgeon pushes a fine needle into the skin and over the contracture, the sharp bevel (slanted tip) of the needle is used to cut the thickened tissue under the skin - the needle is used like a knife/saw.
• Fasciectomy - connective tissue is completely removed. Used in more severe cases.

Physical therapy and occupational therapy - patients may need therapy after a surgical intervention to regain proper hand function.

Collagenase - the US FDA approved the use of injectable collagenase extracted from clostridium histolyticum (Xiaflex). The enzyme collagenase is injected into the cords and dissolves them. It is still early days to say how effective this treatment is long-term.

Steroid injections - in mild cases the bumps of tissue may become softened and flattened with steroid injections.

Written by Christian Nordqvist


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