What is it?
Dupuytren’s contracture is when one or more of the fingers become permanently bent in a flexed position. The condition can begin as small hard nodules that form just under the skin of the palm, which worsens over time until the fingers can no longer be straightened.
Why does it occur?
Often initially mistaken for a blister or callus, Dupuytren’s disease is a benign thickening of the connective tissue during the progression of which string like cords develop beneath the skin pulling the fingers affected towards the palm of the hand. Smoking, diabetes and some types of medication have been linked to the condition, but the exact cause is still unknown.
What are the symptoms?
Itching, pain, cramp and discomfort are reported by some patients, yet others don’t have any negative sensations at all. Symptoms can be mild and often painless, and may not require treatment. It is a progressive condition, though, that will worsen over time. Should one or more of the fingers become permanently bent, it can make daily activities, like doing and undoing buttons, much more difficult.
How is it diagnosed?
A diagnosis can usually be done simply by your consultant looking at and feeling your hand. They may ask when you first noticed any change or if you have had any sort of related trauma or injury. Your consultant may do a table top test, meaning they will ask you to place your palm on a straight surface to see if it will lie flat.
How is it treated?
The best course of treatment will depend on the severity of the condition, and the benefits of the different treatment options will be explained to you.
Your consultant may prescribe some hand exercises that you can perform to help increase the function of and reduce the pain in your hand.
Needling, or needle aponeurotomy, is a minimally invasive procedure that uses the point of a needle to sever the tightened cords and relieve contractures. Small punctures are made in the skin and by manipulating the tip of the needle, your consultant can cut through the contracted tissue.
They may also inject enzymes into the affected area that help soften and weaken the tightened cord, which then makes it easier for your consultant to manipulate the hand, and for the cord to be removed.
Or your consultant may try Dupuytren’s tape, which can helps to restore the range of motion of your hand. This treatment can be particularly effective if used in the early stage.
Surgery has long been the most common form of treatment for Dupuytren’s contracture. There are many variations to how surgery can be done and how extensive it needs to be. When surgery is performed, an incision is typically made directly on top of the area of Dupuytren’s, the abnormal tissue is removed, and the incisions are sutured closed.
The advantage of surgical treatment is that, even in the most advanced stages of Dupuytren’s, there is usually something that can be done from a surgical standpoint. More extensive Dupuytren’s may require a more extensive surgery, but it almost always can be addressed through an incision.
In addition, while all of these procedures address the contracted tissue of Dupuytren’s, none of them cure the underlying condition called Dupuytren’s disease. Therefore, recurrence of the contracture is always a possibility, no matter what treatment is performed.
In some cases, when symptoms are severe, or in those for whom more conservative treatments have not worked, surgery may be the best option. This will involve the release of the sheath surrounding the affected tendons at the base of the thumb, which reduces pressure and enables the tendons to glide freely, helps restore proper finger motion and reduces any pain.
The One Orthopaedics team specialists
Consultant Hand Surgeon, FRCS
Consultant Orthopaedic Specialist FRCS (Tr & Orth)