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Dupuytrens Contracture
Personalized care for your hands
Dupuytren’s contracture is an abnormal thickening and tightening of the normally elastic tissue beneath the skin of the palm and fingers. This tissue is called fascia. The fascia contains strands of fibers, like cords, that run from the palm upward into the fingers.
In Dupuytren’s contracture, these cords tighten, or contract, causing the fingers to curl forward. In severe cases, it can lead to crippling hand deformities.
Causes of of Dupuytrens Contracture
The cause of Dupuytren’s contracture, also called Dupuytren’s disease, is unknown, but certain biochemical factors that affect the palm’s connective tissue may be involved. Injuries and overuse of the hand do not play a role. Tendons are not affected.
However, certain things may make you more likely to develop Dupuytren’s contracture. They include:
Drinking a lot of alcohol, although most people with the disease do not have alcoholism
Diabetes
Seizures, such as those seen in people with epilepsy
Smoking
Symptoms of Dupuytrens Contracture
Dupuytren’s contracture typically progresses slowly, over years. The condition usually begins as a thickening of the skin on the palm of your hand. As it progresses, the skin on your palm might appear puckered or dimpled. A firm lump of tissue can form on your palm. This lump might be sensitive to the touch but usually isn’t painful.
In later stages of Dupuytren’s contracture, cords of tissue form under the skin on your palm and can extend up to your fingers. As these cords tighten, your fingers might be pulled toward your palm, sometimes severely.
The ring finger and pinky are most commonly affected, though the middle finger also can be involved. Only rarely are the thumb and index finger affected. Dupuytren’s contracture can occur in both hands, though one hand is usually affected more severely.
Risk Factors of getting Dupuytrens Contracture
A number of factors are believed to increase your risk of the disease, including:
- Age. Dupuytren’s contracture occurs most commonly after the age of 50.
- Sex. Men are more likely to develop Dupuytren’s and to have more severe contractures than are women.
- Ancestry. People of Northern European descent are at higher risk of the disease.
- Family history. Dupuytren’s contracture often runs in families.
- Tobacco and alcohol use. Smoking is associated with an increased risk of Dupuytren’s contracture, perhaps because of microscopic changes within blood vessels caused by smoking. Alcohol intake also is associated with Dupuytren’s.
- Diabetes. People with diabetes are reported to have an increased risk of Dupuytren’s contracture.
Treatment of Dupuytrens Contracture
If the disease progresses slowly, causes no pain and has little impact on your ability to use your hands for everyday tasks, you might not need treatment.
Treatment involves removing or breaking apart the cords that are pulling your fingers toward your palm. This can be done in several ways. The choice of procedure depends on the severity of your symptoms and other health problems you may have.
Enzyme injection. Injecting a type of enzyme into the taut cord in your palm can soften and weaken it — allowing your doctor to later manipulate your hand in an attempt to break the cord and straighten your fingers. The advantages and disadvantages of the enzyme injection are similar to needling.
Needling
This technique uses a needle, inserted through your skin, to puncture and break the cord of tissue that’s contracting a finger. Contractures often recur but the procedure can be repeated.
The main advantages of the needling technique are that there is no incision, it can be done on several fingers at the same time, and usually very little physical therapy is needed afterward. The main disadvantage is that it can’t be used in some places in the finger because it could damage a nerve or tendon.
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Surgical treatment of Dupuytrens Contracture
Another option for people with advanced disease, limited function and progressing disease is to surgically remove the tissue in your palm affected by the disease. The main advantage to surgery is that it results in a more complete and longer-lasting release than that provided by the needle or enzyme methods. The main disadvantages are that physical therapy is usually needed after surgery, and recovery can take longer.
In some severe cases, especially if surgery has failed to correct the problem, surgeons remove all the tissue likely to be affected by Dupuytren’s contracture, including the attached skin. In these cases a skin graft is needed to cover the open wound. This surgery is the most invasive option and has the longest recovery time. People usually require months of intensive physical therapy afterward.
Lifestyle and home remedies
If you have mild Dupuytrens contracture, you can protect your hands by:
- Avoiding a tight grip on tools by building up the handles with pipe insulation or cushion tape
- Using gloves with heavy padding during heavy grasping tasks
However, your condition may persist or worsen, despite these precautions.