Dupuytren’s Contracture

Dupuytren’s contracture is thickening of the fibrous tissue layer under the skin of palms, fingers, and hands which leads to curving of the finger. It is caused due to the excessive production of collagen which gets deposited under the skin. Hereditary factors, excessive alcohol consumption, diabetes, seizures, and increased age may increase the risk of developing the condition. It commonly occurs in the ring finger and little finger. Occasionally the middle finger is affected but the thumb and index finger are rarely affected. Dupuytren’s contracture is a condition that usually progresses slowly over many years and is not painful. However, some cases progress rapidly and may be painful to the patient.

Symptoms

The most commonly observed symptoms of Dupuytren’s contracture are lumps or nodules in the palm, difficulty in straightening the finger, and contracture of the nodules which forms tough bands under the skin.

Causes and Risk factors

The cause of Dupuytren’s contracture is unknown. However, there are certain risk factors that may increase your chance of developing the condition. These can include the following:

• Age: It occurs more frequently around ages 40.
• Social Habits: Smoking and drinking alcohol may increase your risk of developing the condition
• Medical Conditions: Patients with diabetes, alcoholism, cirrhosis of the liver, and seizure disorders appear to be at increased risk of developing the condition.
• Gender: The condition is more common in males than females.
• Heredity: The condition tends to run in families.
• Ancestry: Most commonly affected are northern Europeans and people of Scandinavian descent.

Diagnosis

Hand and wrist conditions should be evaluated by an orthopaedic hand surgeon for proper diagnosis and treatment. Your surgeon will collect medical history and perform physical examination. Dupuytren’s contracture is diagnosed based on the history and physical and without any special testing required.

Conservative Treatment Options

You may not need treatment for Dupuytren’s contracture if the condition is not affecting your ability to perform daily activities. However, if you are experiencing pain or if having difficulty using your hands for everyday activities, your surgeon will recommend conservative treatment options to treat your condition. Treatment options will vary depending on the severity of the condition. The conservative approaches include:

• Heat: Applying heat to the palms of the hand prior to massage or exercise can help to loosen the tissues.
• Massage: Gently massage the thickened tissues of the palm.
• Exercises: Stretching exercises such as bending the fingers away from the palm may be useful.
• Injections: Steroid injections in the palm may be done to relieve local inflammation.
• Needle Aponeurotomy: This procedure involves inserting a small needle into the thickened palm tissue and manipulating it to loosen and break up the contracting tissue. Ultrasound may be used to guide the needle to avoid hitting nerves or tendons.
• Collagenase Injection: An enzymatic drug that breaks down collagen can be injected into the corded tissue to soften and weaken the contracture. The physician then manipulates the tissue manually to break up the tissue.

Surgical Procedure

If conservative treatment options fail to resolve the condition and symptoms persist for 6 months or more and your quality of life is adversely affected, your surgeon may recommend you undergo a surgical procedure to open the tendon sheath and allow more room for tendon movement.

This surgery is usually performed in an operating room under local or regional anaesthesia on an outpatient basis as day surgery. Your surgeon makes a small incision to the affected palm area. The surgeon then removes the thickened fibrous tissue causing the contracture. The incision is then closed with sutures and covered with a sterile dressing.

Risks and Complications

Complications can be medical (general) or specific to hand surgery. Medical complications include those of the anaesthetic and your general wellbeing. Some of the complications associated with the surgery include:

• Infection
• Nerve damage causing weakness, paralysis, or loss of feeling in the hand area
• Injury to the arteries of the fingers/hand
• Recurrence
• Allergic reactions to medications
• Blood loss requiring blood transfusions
• Heart conditions
• Serious medical problems can lead to on-going health concerns, prolonged hospitalization, or rarely death.