What Is Dupuytren’s Contracture?
Dupuytren’s contracture, named after the nineteenth-century French surgeon who first described it, is a painless and usually progressive disorder characterized by the hardening of a band of tissue just beneath the skin on the palm of the hand (palmar fascia). For unknown reasons, the tissue hardens and shrinks into a fibrous, scarlike mass.
It initially appears as a puckering on the palm of the hand, just below the fingers. As the condition progresses, the contracted tissue pulls one or more of the fingers inward, so that it becomes increasingly difficult, if not impossible, to straighten out the affected digits.
Ordinarily, the ring and little fingers are affected, but the middle and index fingers and even the thumbs are sometimes involved. (Although Dupuytren’s contracture typically affects the handsusually both of themthe feet and toes also are sometimes affected.) In most cases, the condition is nothing to worry about; it is rarely painful, and it causes few limitations. But should it begin to interfere with normal activities, minor surgery can correct the problem.
What Causes Dupuytren’s Contracture?
- The cause of Dupuytren’s contracture is unknown.
- Age, gender, and hereditary factors play a role in the development of Dupuytren’s contracture. Older men—particularly those of northern European descent—are most likely to be affected. In fact, one in five white men over the age of 65 has some signs of the condition.
- Diabetes, lung disease, epilepsy, and alcoholism have been associated with Dupuytren’s contracture.
- People whose occupations require the use of handheld tools (especially tools that vibrate, such as jackhammers, electric drills, and chainsaws) may have an increased risk of developing the condition.
Symptoms of Dupuytren’s Contracture
- A thickened lump of tissue in the palm of the hand at the base of a finger
- Puckering of the skin above the lump
- Weakness in the grasp
- Inability to fully straighten one or more fingers, most commonly the ring and little fingers
Preventing Dupuytren’s Contracture
- There is no known way to prevent Dupuytren’s contracture.
Diagnosis of Dupuytren’s Contracture
- Physical examination and patient history are usually all that is required to make a diagnosis.
- A useful test for the disease is to try to lay the hand flat, palm side down, on a table. If this cannot be done because the fingers stay bent, the disease is likely present.
How to Treat Dupuytren’s Contracture
- No treatment is needed unless the contracture interferes with the use of the hand. Splints may be helpful in slowing the contraction of the fingers.
- Physical therapy and corticosteroid injections may ease symptoms.
- Collagenase clostridium histolyticum (Xiaflex®) may be used to treat Dupuytren's contracture in adults with a palpable cord.
- If the use of the hand is impaired, surgery can be performed to correct the problem. Sometimes a skin graft is necessary.
- Steroid injections may help relieve pain.
- Following surgery, physical therapy may restore mobility and strength in the affected area. However, the ability to perform precision work, such as playing a musical instrument, may not be fully regained. Some numbness may result after surgery if the contracture involved any nearby nerves.
When to Call a Doctor
- Make an appointment with a doctor if the inability to straighten your fingers interferes with normal activities.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media