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Dupuytren’s Contracture

Dupuytren’s contracture refers to a condition that affects the hands and the fingers. It occurs when the fibrous tissue in the palm and finger thicken which can cause one or more fingers to bend towards the palm of the hand.

Dupuytren’s contracture typically develops slowly and can affect one or both hands. The ring finger is the most frequently affected, followed by the little, middle and index fingers. It usually occurs after the age of 40 and is more commonly seen in men than women. While the cause is not known, there are factors that put individuals at a greater risk for developing the condition. Dupuytren’s contracture often runs in families and is seen more frequently in people of Northern European ancestry. Additional risk factors include alcohol use, diabetes, seizure disorders, and smoking.

The condition begins with the formation of a small tender nodule of thickened tissue under the skin of the palm. Initially the nodule may feel tender, but this subsides. Other nodules may then develop. Over time these nodules can thicken and extend, forming tough bands of tissue. When these cords of tissue contract, one or more fingers may curl towards the palm. Although these contractures are often mild, they can get worse with time. In more advanced cases, it can be difficult to straighten the involved fingers. This may interfere with the normal use of the hand.

Characteristic signs of Dupuytren’s contracture include:

  • Difficulty or inability to extend or straighten the fingers
  • Dimples or pitted marks in the skin of the palm
  • The appearance of a rope-like band and nodules in the palm and underside of the fingers
  • Although an uncommon occurrence, burning or itching in the dimpled areas may be experienced

While there is no cure for the condition, the disease progresses slowly and may not be troublesome for a long time. A number of treatments are available, ranging from conservative approaches to surgical procedures.

Non-surgical therapy may involve exercises, warm water baths, stretching, and splints. Steroid injections may be used to relieve symptoms as well as inhibiting continued tissue thickening. A more recent non-surgical approach involves the injection of an enzyme to break down the tough bands and improve motion without an invasive procedure.

When the condition has progressed so significantly that hand function is severely limited, surgery may be indicated. The surgical procedure selected depends on the specifics of the case.