Dupuytren's contracture

The palm of the hand contains a deep layer of tissue called the palmar fascia, which extends across the palm to the fingers. Dupuytren’s contracture is a thickening and shortening of this web of fascia that gradually causes clawing of the fingers as they are pulled towards the palm. The ring and little finger are usually targeted, but any finger can be affected.

The condition tends to progress in fits and starts, and may take decades to finally limit the functioning of the hand. The exact cause is unknown, but the incidence of Dupuytren’s contracture is higher among certain groups including: people who abuse alcohol. Dupuytren’s contracture can sometimes run in families, which suggests a genetic susceptibility.

Treatment depends on the severity of the condition, but may include injections of corticosteroids into the palm and surgery. The features include:

• A lump or nodule appears on the palm
• usually close to the base of the ring or little finger. There is the appearance of a thickened cord running along the palm to the fingers

Over time, as the contracture develops, the fingers become clawed as they are pulled towards the palm.

The hand bows

The fingers are completely pulled against the palm

Often, the skin of the palm is dimpled and puckered.

There is rarely any associated pain

The exact trigger that causes the palmar fascia to thicken and contract is unknown. Potential risk factors include manual labour with vibration exposure, prior hand trauma, smoking, hyperlipidemia, Peyronie disease and complex regional pain syndrome (CRPS). A family history of the condition is often present.

Other contributing factors may include:

• Age – the condition is more common in middle to later years of life. Gender – males are three times as likely to develop disease
• are more likely to have the condition with more severity. Ancestry – those with Celtic or Scandinavian ancestry are at increased risk

Certain medical conditions – people with diabetes and epilepsy have a higher incidence of the condition, while those with rheumatoid arthritis have lower incidence. Alcoholism – the contracture tends to be common, and comparatively more severe, in alcoholics. In most cases, only the hands are affected.

Other associated difficulties can include:

• – the finger joints on the same hand may enlarge
• thicken. – creates thickening
• shortening of the foot’s deep connective tissue. As the disease progresses
• it can cause quite severe pain while walking

Treatment depends on the severity of the condition

In its earlier stages, treatment may include injections of corticosteroids into the fascia. These medications reduce any localised tenderness and may help to delay subsequent thickening of the tissue. More recent treatments showing promise include therapy with calcium channel blockers, treatment with gamma-interferon and percutaneous needle fasciotomy.

In severe or advanced cases, the person is unable to lay their hand palm-down on a flat surface, or their fingers have contracted into their palm so that the hand is no longer functional.

Surgery is then the best option

Dupuytren’s contracture can sometimes return after surgery, either at the same site or elsewhere on the palm. Usually, the contracture progresses at the same speed as previously. Depending on the severity of the condition, surgery options may include:

• amputation of an affected finger
• if the contracture has returned so many times that corrective surgery is no longer possible

Occupational therapy is needed after surgery to speed recovery and reduce the risks of the contracture returning. Techniques may include:

• associated skin
• using a skin graft to seal the palm Occupational therapy for Dupuytren’s contracture splints worn at night for a few months to straighten the finger sometimes
• a splint worn during the day special hand exercises to encourage flexibility Where to get help Your doctor A plastic surgeon

Key Points

• exact trigger that causes the palmar fascia to thicken and contract is unknown
• Other contributing factors may include: Age – the condition is more common in middle to later years of life
• Ancestry – those with Celtic or Scandinavian ancestry are at increased risk
• Alcoholism – the contracture tends to be common, and comparatively more severe, in alcoholics
• As the disease progresses, it can cause quite severe pain while walking