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Dupuytren's contractureBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/dupuytrens-contracture/DS00732
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Dupuytren's (du-pwe-TRANZ) contracture is a hand deformity that usually develops slowly, over years. Dupuytren's contracture affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin — eventually forming a thick cord that can pull one or more of your fingers into a bent position.
Once this occurs, the fingers affected by Dupuytren's contracture can't be straightened completely, which can complicate everyday activities such as placing your hands in your pockets, putting on gloves or shaking hands.
Dupuytren's contracture most commonly affects the ring finger and pinky, and occurs most often in older men of Northern European descent. A number of treatments are available to slow the progression of Dupuytren's contracture and relieve symptoms.
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Dupuytren's contracture typically progresses slowly, over years. Occasionally it can develop over weeks or months. In some people it progresses steadily, and in others it may start and stop.
Dupuytren's contracture usually begins as a thickening of the skin on the palm of your hand. As Dupuytren's contracture progresses, the skin on the palm of your hand may appear puckered or dimpled. A firm lump of tissue may form on your palm. This lump may 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 may extend up to your fingers. As these cords tighten, your fingers may be pulled toward your palm, sometimes severely.
The ring finger and pinky are most commonly affected, though the middle finger also may 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 than the other.
Doctors don't know what causes Dupuytren's contracture. Some researchers have speculated that it may be associated with an autoimmune reaction, where a person's immune system attacks its own body tissues. Dupuytren's often occurs in concert with conditions that cause contractures in other parts of the body, such as the feet or penis.
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.
- Your 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.
Dupuytren's contracture can make it difficult to perform certain functions using your hand. Since the thumb and index finger aren't usually affected, many people don't experience much inconvenience or disability with fine activities such as writing. But as Dupuytren's contracture progresses, it can limit your ability to fully open your hand and make it difficult to grasp large objects or to get your hand into narrow places.
Preparing for your appointment
While you may initially bring your symptoms to the attention of your family doctor, he or she may refer you to an orthopedic surgeon.
What you can do
Before your appointment, you may want to write a list that answers the following questions:
- Do you have a family history of this problem?
- What treatments have you already tried? Did they help?
- What medications and supplements do you take regularly?
What to expect from your doctor
Your doctor may ask some of the following questions:
- When did your symptoms begin?
- Have they been getting worse?
- Is your hand painful?
- How does the contracture interfere with your day-to-day tasks?
Tests and diagnosis
During the physical exam, your doctor will visually inspect your hands closely, comparing them to each other and checking for any puckering on the skin of your palms. He or she will also press on different parts of your hands and fingers to check for toughened knots or bands of tissue.
In most cases, doctors can diagnose Dupuytren's contracture simply by looking at and feeling your hands. Other tests are rarely necessary.
Treatments and drugs
If the disease progresses slowly, causes no pain and has little impact on your ability to use your hands for everyday tasks, you may not need treatment. Instead, you may choose to wait and see if Dupuytren's contracture progresses.
Treatment involves removing or breaking apart the cords that are pulling your fingers in toward your palm. This can be done in several different ways. The choice of procedure depends on the severity of your symptoms and any other health problems you may have.
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 cannot be used in some locations in the finger, because it could damage a nerve or tendon.
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, except that the enzyme injection may be more painful initially.
Another option is to surgically remove the tissue in your palm affected by the disease. This may be challenging because it's difficult to identify tissue in very early stages of the disease. Diseased tissue may also attach to the skin, making it difficult to remove and increasing the chances of recurrence.
The main advantage to surgery is that it results in a more complete joint release than that provided by the needle or enzyme methods. The main disadvantages are that physical therapy is usually needed after surgery, and the recovery time can be longer.
In some severe cases, surgeons remove all the tissue likely to be affected by Dupuytren's contracture, including the attached skin. In these cases a skin graft will be 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 Dupuytren's contracture, you may want to:
- Stretch your fingers. Gently bend your fingers backward from your palm. One way to do this is to place your fingers on the edge of a table, palm down, and then lift the palm upward gradually as you keep your fingers flat on the table.
- Use massage and heat. Before stretching, warm up your hands with a microwavable heat pack and then massage your palms with lanolin cream.
- Protect your hands. Avoid a tight grip on tools by building up the handles with pipe insulation or cushion tape. Use gloves with heavy padding during heavy grasping tasks.
- Canale ST, et al. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa.: Mosby Elsevier; 2008. http://www.mdconsult.com/das/book/body/208746819-4/0/1584/0.html. Accessed Aug. 17, 2012.
- Sheon RP, et al. Dupuytren's contracture. http://www.uptodate.com/index. Accessed Aug. 17, 2012.
- Frontera WR, et al. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/208746819-6/0/1678/0.html. Accessed Aug. 17, 2012.
- Dupuytren's contracture. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00008. Accessed Aug. 20, 2012.
- Dupuytren's disease. American Society for Surgery of the Hand. http://www.assh.org/Public/HandConditions/Pages/DupuytrensDisease.aspx. Accessed Aug. 20, 2012.