What is Dupuytren’s contracture?
Dupuytren’s contracture is a hand deformity that usually develops over years. The condition affects a layer of tissue, called “fascia”, that lies under the skin of your palm. This fascia thickens and tightens with time, forming knots of tissue under the skin – eventually creating a thick cord that can pull one or more fingers into a bent position. The affected fingers are unable to straighten completely, which can complicate everyday activities such as placing your hands in your pockets, grasping objects or shaking hands.
The cause of Dupuytren’s contracture is not completely known, but most evidence points towards genetics as having the most important role. Factors that are believed to contribute to the development or worsening of Dupuytren’s contracture include:
- Gender – men are more likely to develop the condition than women.
- Ancestry – people of northern European and Scandinavian ancestry are more likely to develop the condition.
- Heredity – Dupuytren’s contracture often runs in families.
- Tobacco and alcohol use – smoking and alcohol intake are associated with an increased risk of Dupuytren’s contracture.
- Certain medical conditions – people with diabetes and seizure disorders are more likely to have Dupuytren’s contracture.
- Age – the incidence of the condition increases with age.
How do I know if I have Dupuytren’s contracture?
Signs and symptoms of Dupuytren’s contracture may include:
- Development of one or more small lumps, or nodules, in the palm of your hand. These nodules are typically fixed to the overlying skin. Initially, the nodules may feel tender but, over time, this tenderness may go away. In some cases, there can be “pitting” or deep indentation of the skin near the nodules.
- Over time, the nodules may thicken and contract, contributing to the formation of dense and tough cords of tissue under the skin.
- As the tissue under the skin tightens, one or more of your fingers may be pulled toward your palm and may be restricted from straightening and/or spreading apart. The ring and little fingers are most commonly affected, but any or all of the fingers can be involved, even the thumb.
How is Dupuytren’s contracture diagnosed?
Your specialist Doctor will obtain your health history and perform a physical examination. Your hands will be compared to each other, checked for puckering on the skin of your palms, with the nodules and cords on your palm located, and range of movement of your fingers and thumb measured.
How is Dupuytren’s contracture treated?
Currently, there is no cure for Dupuytren’s contracture. However, the condition usually progresses very slowly and may not affect function for many years. In fact, for some patients, the condition may never progress beyond developing lumps in the palm. If the condition progresses, it may be treated both surgically and non-surgically, depending on the severity of the injury.
Finger contractures that are mild may be managed without surgery. You may be referred to a Hand Therapist for stretching exercises and for fabrication of a customised finger splint to help straighten the affected finger. Other non-surgical interventions such as corticosteroid injections to help slow the progression of a contracture may also be suggested.
If the contracture interferes with hand function, your specialist Doctor may recommend surgery. The goal of surgery is to reduce the contracture and improve movement in the affected fingers. Treatment involves removing or breaking apart the cords that are pulling your fingers toward your palm. This can be done in several ways, including open surgery, enzyme injection and minimally invasive needling procedure. After surgery, your specialist Doctor may refer you to our Hand Therapist for a customised splint to help protect your hand. When there is adequate healing, you will be able to commence Hand Therapy.
Joint stiffness, muscle tightness and loss of function of the fingers are common problems in both non-surgical and surgical treatment methods. As such, daily activities such as self-care (e.g. dressing, showering, brushing of teeth), work activities and leisure pursuits (e.g. baking, sports, gym activities) are often affected. Hand therapy plays a pivotal role in the recovery of finger movements, strength and function.
You may be referred to our Hand Therapist for splint fabrication. Once you are able to start therapy for your finger, hand and wrist, our Hand Therapist can then help you in your recovery through treatment options such as:
- Advice and education pertaining to your condition
- Wax therapy
- Ultrasound therapy
- Exercises to improve finger joint and muscle movements
- Management of swelling
- Scar management
- Strengthening exercises
- Soft tissue mobilisation and release
- Pain relief/management
- Functional retraining of the finger and hand
- Personalised home exercise program