Dupuytren’s contracture (also commonly referred to as “Dupuytren’s disease”) is one of the many hand conditions that can be treated at Swift Institute in Reno and Carson City. This condition develops when the fascia (the layer of tissue under the skin covering the palm and fingers) begins to thicken, tighten, and form knots, gradually turning into a thick cord that forces one or more fingers (generally the ring finger or pinky finger) to bend toward the palm. Because the affected fingers cannot be straightened, people living with Dupuytren’s contracture often have trouble completing everyday tasks like shaking hands, wearing gloves, or grasping large objects.
Although Dupuytren’s contracture has no known cause, the following factors may put someone at higher risk of developing the condition:
- Age — People over the age of 40 are more likely to develop this condition than younger individuals.
- Gender — Men have an increased risk of developing this condition.
- Genetics — People whose family members also have Dupuytren’s contracture likewise have a greater chance of developing this condition.
- Ancestry — People of northern European or Scandinavian descent are more likely to develop this condition than people with other backgrounds.
- Other medical issues — People who are living with diabetes or seizure disorders have an increased risk of developing this condition.
- Smoking/drinking — People who smoke cigarettes or consume alcohol have a greater chance of developing this condition than those who abstain.
The professionals at our Reno and Carson City offices often recommend that patients with Dupuytren’s contracture attempt a course of conservative treatment before turning to surgery. This may include needling, enzyme injections, and corticosteroid injections, among other options. If these methods don’t bring relief, there are various surgeries that can be performed to reduce the severity of a contracture and improve a person’s range of motion, including fasciotomies (where the surgeon divides the cord) and subtotal palmar fasciectomies (where the surgeon removes the cord and affected tissue).
If you’re seeking relief from Dupuytren’s contracture, please schedule an appointment at one of our Reno or Carson City offices. We look forward to helping you restore your hand function and mobility.
Symptoms of Dupuytren’s Contracture
Dupuytren’s disease is an abnormal thickening of the tissue just beneath the skin of the palm and fingers known as fascia. Firm cords and lumps may develop that can cause the fingers to bend into the palm, in which case it is described as Dupuytren’s contracture. Although the skin may become involved in the process, the deeper structures, such as the tendons, are not directly involved.
Dupuytren’s contracture symptoms usually occur very gradually. One or more small, tender lumps, or nodules, form in the palm. The lumps are generally firm and adherent to the skin. The nodules may thicken and contract, forming tough cords that extend from the palm into one or more fingers, with the ring and little fingers most commonly affected. These cords may be mistaken for tendons, but they actually occur between the skin and the tendons. These cords cause bending or contractures of the fingers. In many cases, both hands are affected, although the degree of involvement may vary.
The initial nodules may produce discomfort that usually resolves, but Dupuytren’s Contracture is not typically painful. The disease may first be noticed because of difficulty placing the hand flat on an even surface, such as a tabletop. As the fingers are drawn into the palm, you may notice increasing difficulty with activities such as washing, wearing gloves, shaking hands, or putting hands into pockets. Progression is unpredictable. Some individuals will have only small lumps or cords while others will develop severely bent fingers. More severe disease often occurs with an earlier age of onset.
What Causes Dupuytren’s Contracture
The cause of Dupuytren’s Contracture is not known, but may be associated with certain biochemical factors within the involved fascia. It is not caused by an injury or heavy hand use.
There are several factors that put people at risk for developing Dupuytren’s Contracture:
- It is most common in people of Northern European ancestry.
- It often runs in families (hereditary).
- It may be associated with drinking alcohol.
- It is associated with certain medical conditions, such as diabetes and seizures.
- It increases in frequency with age, being more common in men over age 40.
Treatment for Dupuytren’s Contracture
There is no way to stop or cure Dupuytren’s Contracture, and it usually progresses very slowly and may not be troublesome for years. However, it is not dangerous and may never progress beyond lumps in the palm. If the condition does progress, nonsurgical treatment may help to slow the condition.
The goal of treatment is to improve finger position and thereby hand function. Despite treatment, the disease process may recur. Before treatment, your hand surgeon will discuss realistic goals, possible risks and results.
If a lump is painful, an injection of corticosteroid, a powerful anti-inflammatory medication, may help relieve the pain. In some cases, it may prevent the progression of contracture. Several injections may be needed for a lasting effect.
Surgery is recommended when your hand surgeon has confirmed through measurements over time that the disease is progressing. Surgery for Dupuytren’s Contracture divides or removes the thickened bands to help restore finger motion. Sometimes the wound is left open and allowed to heal gradually. Skin grafting may be needed to cover open areas if the existing skin is deficient.
Some swelling and soreness are expected after surgery, but severe problems are rare. After surgery, elevating your hand above your heart and gently moving your fingers will help relieve pain, swelling, and stiffness.
Physical therapy may be helpful during recovery after surgery and can recommend specific exercises can help strengthen your hands and help you move your fingers. Splinting may also be recommended to maximize and maintain the improvement of finger position and function.
Most people will be able to move their fingers better after surgery. Approximately 20% of patients experience some degree of recurrence and may require further surgery.