Dupuytren's Contracture

What is Dupuytren's contracture?

Dupuytren's contracture is a condition in which thickened tissue in the hand forces one or more of your fingers to bend toward the palm.

How does it occur?

The cause of Dupuytren's contracture is not known. In most cases it does not start until after age 40. It tends to be more common in men and in people who have other family members with it. It is also more common in northern Europeans. Alcoholics, diabetics, smokers, and people who are taking anticonvulsant medicine for seizures seem to have a greater risk for this problem. You can get it in 1 or both hands.

What are the symptoms?

A thickening, or nodule, develops in the palm of the hand near the base of the ring or little finger. Sometimes a pit, or indentation, may form in the palm or on the finger. Other nodules may develop and create a cord, or band, that extends from the palm into the finger. This cord tightens and pulls the finger into a bent position toward the palm causing some discomfort. It becomes hard to straighten the finger. The thickened tissue may pull the finger into a completely bent position. It may even get so bad that you cannot use your fingers.

Any of the fingers may be affected, but it is most common in the ring finger or little finger. Pain is not common with Dupuytren's.

If the condition gets worse quickly, the fingers can become bent within a few weeks or months. But this is rare. It is more common for a finger to take several years to reach the bent position.

How is it treated?

Dupuytren's contracture can be treated with a steroid shot. In the early stage of the problem this can prevent or slow the thickening and stiffening of the tissues. Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.

Other treatments for Dupuytren’s contracture are:

• Using a needle to break up the stiff, contracting tissues. First your healthcare provider numbs the area. Then your provider puts a needle through the skin and tears the attachments of the tissues that are making the finger bend.
• Injecting a medicine called Xiaflex into the affected area. The medicine softens and weakens the thick tissue causing the contracture. The next day your healthcare provider will manipulate your hand to break up the softened cords and try to stretch the fingers into their normal position.
• Having surgery called Dupuytren's contracture release. Your healthcare provider cuts and removes the thickened tissue in the hand. This can be difficult if there is a lot of scarring inside your hand and tissues, including the skin, have grown together.

Surgery is usually suggested only if you have pain or discomfort that is extreme or if you cannot use your hand. Your healthcare provider may suggest surgery if it is impossible to put your hand flat on a table.

If you have surgery, you should not use your hand for several weeks after the procedure. You may have to wear a bulky dressing, cast, or splint for a while. You will likely have physical therapy for 1 to 2 months after surgery.

How long will the effects last?

The disease may worsen very slowly, but it will not go away. Your healthcare provider will want to see you about every 6 months to check for worsening of the problem. Your provider can then suggest surgery if and when it becomes necessary.

The results of surgery are usually good. You may get back full use of your fingers and hand. However, Dupuytren's can come back after treatment.

How can I help prevent Dupuytren's contracture?

There is no way to prevent Dupuytren's. However, not smoking and having a healthy lifestyle helps to prevent conditions that may be a factor in developing Dupuytren's, such as diabetes or alcoholism.