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Dupuytren contracture

Definition

Dupuytrens contracture is a painless thickening and tightening (contracture) of tissue beneath the skin on the palm of the hand and fingers.

Alternative Names

Palmar fascial fibromatosis - Dupuytren; Flexion contracture - Dupuytren; Needle aponeurotomy - Dupuytren; Needle release - Dupuytren; Percutaneous needle fasciotomy - Dupuytren; Fasciotomy- Dupuytren; Enzyme injection - Dupuytren; Collagenase injection - Dupuytren; Fasciotomy - enzymatic - Dupuytren

Causes

The cause is unknown. Family history of Dupuytren contracture makes you more likely to develop this condition. It does not seem to be caused by occupation or from trauma.

The condition is more common after age 40. Men are affected more often than women. Risk factors are alcohol use, diabetes, and smoking.

Symptoms

One or both hands may be affected. The ring finger is affected most often, followed by the little, middle, and index fingers.

A small, nodule or lump develops in the tissue below the skin on the palm side of the hand. Over time, it thickens into a cord-like band. Usually, there is no pain. In rare cases, the tendons or joints become inflamed and painful. Other possible symptoms are itching, pressure, burning, or tension.

As time passes, it becomes difficult to extend or straighten the fingers. In severe cases, straightening them is impossible.

Exams and Tests

The doctor will examine your hands. Diagnosis can usually be made from the telltale signs of the condition. Other tests are rarely needed.

Treatment

If the condition is not severe, your doctor may recommend exercises, warm water baths, stretching, or splints.

Your doctor may recommend treatment that involves injecting medicine or a substance into the scarred or fibrous tissue:

  • Corticosteroid medicine relieves inflammation and pain. It also works by not allowing thickening of the tissue to get worse. In some cases, it heals the tissue completely. Several treatments are usually needed.
  • Collagenase is a substance known as an enzyme. It is injected into the thickened tissue to break it down. This treatment may be just as effective as surgery.

Surgery may be done to remove the affected tissue. Surgery is usually recommended in severe cases when the finger can no longer be extended. Physical therapy exercises after surgery help the hand recover normal movement.

A procedure is called aponeurotomy may be recommended. This involves inserting a small needle into the affected area to divide and cut the thickened bands of tissue. There is usually little pain afterward. Healing is faster than surgery.

Radiation is another treatment option. It is used for mild cases of contracture, when the tissue is not so thick. Radiation therapy may stop or slow thickening of the tissue. It is usually done only one time.

Talk to your doctor about the risks and benefits of the different kinds of treatments.

Outlook (Prognosis)

The disorder progresses at an unpredictable rate. Surgery can usually restore normal movement to the fingers. The disease can recur within 10 years after surgery in up to half of cases.

Possible Complications

Worsening of the contracture may result in deformity and loss of function of the hand.

There is a risk of injury to blood vessels and nerves during surgery or aponeurotomy.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of this disorder.

Also call if you lose feeling in your finger or if you finger tips feel cold and turn blue.

Prevention

Awareness of risk factors may allow early detection and treatment.

References

Calandruccio JH. Carpal tunnel syndrome, ulnar tunnel syndrome, and stenosing tenosynovitis. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 75.

McGrouther DA, Jenkins A, Brown S, Gerber RA, Szczypa P, Cohen B. The efficacy and safety of collagenase clostridium histolyticum in the treatment of patients with moderate Dupuytren's contracture. Curr Med Res Opin. 2014;30:733-9. PMID: 24397625 www.ncbi.nlm.nih.gov/pubmed/24397625.

Murphy A, Lalonde DH, Eaton C, et al. Minimally invasive options in Dupuytren's contracture: aponeurotomy, enzymes, stretching, and fat grafting. Plast Reconstr Surg. 2014;134:822e-9e. PMID: 25347658 www.ncbi.nlm.nih.gov/pubmed/25347658.

Stretanski MF. Dupuytren contracture.In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 29.

Review Date:5/9/2015
Reviewed By:C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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Outcome Data

No data available for this condition/procedure.

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