Dupuytren Contracture: Signs, Symptoms, & Treatments

Dupuytren’s contracture is a troublesome condition that affects how your fingers sit, flex, and move. This disease progresses gradually over time and may cause worsening symptoms over the years. The sooner you can identify and address Dupuytren’s contracture, the more options you’ll have for addressing it.

What Is Dupuytren’s Contracture?

Dupuytren’s contracture, also known as Dupuytren’s disease, is a progressive condition in which collagen knots form and the fascia thickens abnormally. The fascia is a fibrous layer of connective tissue underneath the skin. Healthy fascia is strong, stretchy, and flexible, allowing for easy movement. When the fascia thickens, it can restrict movement and inhibit flexibility.

Dupuytren’s contracture typically affects the ring and pinky finger of the hand. It can affect other fingers as well, and in rare cases, Dupuytren’s contracture can occur in the feet. You may even experience a Dupuytren’s fracture in both hands. As this condition progresses, the thickened fascia forms a cord that pulls the fingers sideways or inward toward the palm of the hand.

Dupuytren’s fracture can inhibit many everyday activities such as shaking hands or typing. Though there’s no cure for this condition, there are treatments available to help manage the symptoms.

Signs and Symptoms of Dupuytren’s Contracture

Dupuytren’s contracture usually begins with the formation of small nodules at the base of the fingers or on the palm of the hand. These small lumps are usually tender at first, but the tenderness goes away over time. For this reason, you may not realize the severity of your condition until it has progressed further.

As the nodules in the hand thicken and tighten, they can form bands of connective tissue. At this point in the disease, you may find that you can no longer lay your hand flat on a tabletop. The fingers will start to pull forward noticeably, and you may have difficulty moving or manipulating your hand. Dupuytren’s contracture can create pits in the skin where it’s compressed by the affected finger. These pits are often extremely tender and may result in skin loss along these areas.

Diagnosing Dupuytren’s Contracture

Your health care provider can typically diagnose Dupuytren’s contracture with a visual examination. They’ll look at your hand and fingers and evaluate the range of motion. With a special tool, the doctor can measure exactly how far your fingers have contracted. They may also test your pinch strength and grip and check for feeling and flexibility in each of your fingers as well as your thumb.

Causes of Dupuytren’s Contracture

The exact cause of Dupuytren’s contracture is unknown, though it has a markedly higher prevalence in some populations than others. Dupuytren’s contracture is hereditary, making it more likely if you have a family history of this condition. It usually begins in middle age between 40 and 70 years old. The condition is more common among men than women, and symptoms also progress more quickly in men than in women.

Other factors that increase the likelihood of developing Dupuytren’s contracture include:

• Smoking.
• Drinking.
• Diabetes.
• High cholesterol.
• A lower body mass index.
• Thyroid conditions.
• Liver disease.
• Metabolic conditions.
• Taking seizure medications long term.
• Taking antiretroviral medications long term.
• Having poor blood circulation in the hand.

In the United States, Dupuytren’s contracture is more common in people of Northern European descent. However, in a study that evaluated over 6.6 million individuals with Dupuytren’s disease, the highest prevalence was found in Africa, where this condition impacted 17.2% of the population rather than the global average of 8.2%.

Some studies have indicated that you’re more likely to get Dupuytren’s contracture if you use vibrating tools in your work. Prior hand trauma increases the likelihood of developing this condition. One study found that Dupuytren’s contracture was injury induced in about a fifth of patients. Injuries to the hand and wrist seemed to trigger an earlier onset of the condition, though the overall progression was slower in these cases.

Treatment for Dupuytren’s Contracture

There’s no cure for Dupuytren’s contracture, but you may find it a painless condition that creates only a moderate inconvenience. If you find Dupuytren’s contracture uncomfortable, your physician may suggest a steroid injection to ease the pain. This may also slow the progression of the condition. In some cases, the contracture of the fingers is troublesome enough to warrant treatment.

A needle aponeurotomy is one minimally invasive option that may treat Dupuytren’s contracture. In this procedure, the surgeon numbs the affected part of the hand using an injection. Once the area is numb, the surgeon will divide the diseased fascia using a needle. This process does not require an incision. A needle aponeurotomy may not be possible if the affected tissue is too close to a nerve or tendon, as your surgeon will not want to risk damaging this part of the hand.

An enzyme injection is another possible treatment for Dupuytren’s contracture. As with the needle aponeurotomy, this procedure begins with the surgeon numbing your hand. They’ll then inject an enzyme into the affected tissue. This breaks down the tough bands that have formed so the fingers can lay flat. The next day, the surgeon performs a second procedure in which they snap these bands by manipulating the position of your hand.

In severe cases, your doctor may recommend surgery for Dupuytren’s contracture. During this procedure, the surgeon will remove the affected tissue to release the fingers. The surgeon may also need to remove the skin connected to this tissue and replace it with a skin graft.

Regardless of the treatment option, it’s possible for Dupuytren’s contracture to recur. In most cases, repeat procedures are possible to continually combat the effects of Dupuytren’s disease.

Talk to a Doctor About Your Hand and Wrist Concerns

Since Dupuytren’s contracture is a progressive disease, it’s best to address it as early as possible. If you have unusual pain, discomfort, or nodules in your hands, you should talk to a doctor. Our team at The Hand and Wrist Institute with locations across Texas is uniquely skilled in handling Dupuytren’s contracture and other similar hand conditions. Contact us for an appointment.

persons hand on black background by Nsey Benajah is licensed with Unsplash License

Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.