Dupuytren's Contracture

Definition

Dupuytren's Contracture is a disorder of the hand in which the ring and little fingers become fixed in a bent position and can be straighten only by an operation. In about half of the cases, both hands are affected.

The disorder was named after the French surgeon who first described it, Baron Guillaume Dupuytren.

Causes and Risk Factors

The cause of the disorder is unclear. In most cases there is no apparent or known cause, although the condition is slightly more common in certain groups - for example, in people whose work involves gripping tools, especially those that vibrate.

The condition is a common feature in people with alcoholic liver cirrhosis and some systematic degenerative diseases, such as diabetes.

There is a slight tendency for the condition to run in families, though this does not necessarily mean it is inherited genetically.

Men over 40 are the most commonly affected.

Symptoms

The tissues under the skin in the palm of the hand become thickened and shorten, with tethering of the tendons that run into the fingers. A small, hard nodule forms on the palm of the hand and spreads to form a band of hard tissue under the skin, with puckering of the skin itself.

The affected fingers start to bend more and more over a period of months or years and cannot be pulled back straight.

The order of finger involvement in terms of most to least common is: ring, small, long, thumb, and index.

Diagnosis

This problem is diagnosed through a clinical exam.

Treatment

No proven effective treatment is known. Local corticosteroid injection into the affected tendon sheaths, analgesics, and physiotherapy are, as a rule, ineffective. The only effective treatment for the problem is surgery.

If one very superficial fascial band is present, it may be transected with temporary relief of the contracture (a drawing together, as of muscle or scar tissue, resulting in deformity).

More permanent relief can be obtained by removing the diseased fascia (fibrous membrane covering, supporting, separating muscles uniting the skin with underlying tissue).

The development of disease in a new location or recurrence at a previous surgery site can occur. This is most common in the little finger. Whirlpool baths, passive and active exercises, and posterior extension splints may be helpful postoperatively.

Questions to Ask Your Doctor

Will surgery be recommended?

What is the surgical procedure?

What can be expected after the surgery?

What treatment will be recommended after surgery?

What range of movement of the finger or fingers will be obtained after surgery?

What are the chances of the contracture reoccurring?

Are there any alternative treatments?