What is Dupuytren's contracture?
The layer of tissue that lies beneath the skin in the fingers and the palms of the hands is called the fascia. As the fascia thickens and tightens, the fingers bend toward the palm, and it becomes impossible to extend them fully.
The fibrous tissue can create thickened cords in the palm. It usually affects the fourth and fifth fingers, known as the ring finger and the little finger or pinky, but the thickening can extend into any of the digits, including the thumb.
Other names for Dupuytren's contracture are Morbus Dupuytren, Dupuytren's disease, and palmar fibromatosis.
Well-known people with Dupuytren's contracture include the late former President of the United States, Ronald Reagan, and the pianist Misha Dichter.
Dupuytren's contracture happens when changes under the skin of the hand pull the fingers in toward each other.
A contracture is an abnormal shortening of tissue that affects the range of motion.
Dupuytren's contracture is a shortening of the palmar fascia, which is the thin, tough layer of fibrous tissue that lies between the skin of the palm and the underlying tendons, which allow people to flex their fingers.
The symptoms of this condition develop gradually over several years. The first sign is often a tender lump in the palm. There may be some pain at first, but this usually goes away.
Tough bands of tissue may develop, and it will become harder for the individual to stretch out their hand. Although the bands may resemble cords or tendons, the condition does not involve the tendons.
Unusual dimples or lumps may appear in the palm, and the skin may pucker over these.
The contracture will usually pull one or more of the fingers in toward the palm and make it impossible for the person to extend them.
Dupuytren's contracture can affect one or both of the hands. Less commonly, it may affect the toes, known as Ledderhose disease, or the penis, called Peyronie's disease.
The condition is not usually painful, but it makes it harder to use the fingers. The symptoms can range from mild to severe.
Causes and risk factors
Researchers do not yet know precisely what causes Dupuytren's contracture, but they believe that genetic factors play a role.
Studies have found that the condition commonly affects people from Northern Europe.
Other possible risk factors include:
- alcohol consumption
- older age
- specific genes, as it seems to run in families
Dupuytren's contracture can affect a person's ability to carry out daily tasks.
To diagnose Dupuytren's contracture, a doctor will check the hands for dimples, pitted marks, thickened skin, bent fingers, and lumps, or nodules.
They may ask the person to do a "tabletop test," which requires them to place their hand flat on the surface of a table with the palm facing down.
If they cannot flatten their hand, it is likely that they have the condition.
There is no permanent cure for Dupuytren's contracture.
Treatment is usually unnecessary in cases where the contracture is mild and does not stop a person from doing everyday tasks.
However, treatments are available for people with more severe symptoms. These include:
Injecting corticosteroids into a nodule may relieve pain and inflammation, and it may help slow the progression of the condition.
Collagenase clostridium histolyticum (CCH) injections are a relatively new type of treatment.
The United States Food and Drug Administration (FDA) approved CCH for Dupuytren's contracture in 2010 under the brand name Xiaflex.
In this treatment, a doctor will inject the enzyme collagenase into the cords to weaken them. Next, they will pull and break the cords, allowing the fingers to straighten so that the person can use them again.
A 2016 study of 213 people who had received CCH treatment found that 73 percent were very satisfied or satisfied with the results and 21 percent were dissatisfied. Out of the 78 participants who had previously had surgery, 71 percent said that they preferred CCH to surgery.
It is not yet clear how effective this treatment is in the long term. However, the International Dupuytren Society note that recurrence rates are low in clinical trials, with fewer than 5 percent of people getting symptoms again within 4 years.
In some cases, surgery can make it possible for a person to straighten their fingers again.
A doctor may recommend surgery to remove or loosen the cords in cases where:
- the condition is limiting a person's use of the hand
- tissue wrapped around arteries and nerves is raising the risk of injury to them
In some cases, surgeons can perform the procedure using local anesthesia, but, more often, they will use regional or general anesthesia. Either way, the operation is usually an outpatient procedure, meaning that the individual will not need to stay in the hospital overnight.
According to the American Academy of Orthopaedic Surgeons (AAOS), the two most common surgical procedures for Dupuytren's contracture are:
- a fasciotomy
- a subtotal palmar fasciectomy
The surgeon cuts the connective tissue to relieve the tension. They may push a fine needle with a sharp bevel into the skin and over the contracture to use as a knife.
The surgeon will cut or divide the thickened tissue under the skin, but they will not remove it.
The doctor will leave the wound open, and the person may need to use a splint while the wound heals.
Subtotal palmar fasciectomy
The surgeon will remove the connective tissue entirely. They may need to make several incisions, which they will often do in a zigzag pattern.
Occasionally, a person may need a skin graft to help the wound heal.
Physical and occupational therapy
After surgery, a combination of physical and occupational therapy can help a person regain the function of their hand.
Dupuytren's contracture happens when tissue thickens and tightens under the palm, pulling at least one finger in toward the middle of the hand.
The causes are likely to be genetic, and the condition usually progresses slowly over time. Most people do not need treatment, but surgery and other options are available for those who do.