Dupuytren’s Contracture

What is Dupuytren’s Contracture?

Dupuytren’s disease is a painless, and harmless condition that causes an abnormal thickening in the palm. First appearing as nodules, cords (rope-like structures) can form and lead to the fingers being pulled inwards towards the palm. This is known as Dupuytren’s contracture. It can affect any finger but commonly involves the ring and little fingers. In many cases, Dupuytren’s contracture progresses very slowly, and may not become troublesome for many years. For some patients, the condition may never progress beyond developing nodules in the palm and may not need treatment. However, in moderate to severe cases, treatment may be necessary to help ease the contracture and improve finger mobility.
What Are The Symptoms Of Dupuytren’s Contracture?

A lump or pit in the palm is often the first symptom. The lump may or may not be painful in the beginning. It is typically at the base of the finger. The contracture (or bend) happens when the cords grow into the finger causing them to flex or bend, and prevent the finger from straightening. This may result in difficulty with basic tasks such as picking up change, wearing gloves, or putting your hand in your pocket.

What Causes Dupuytren’s Contracture?

Although the cause of Dupuytren’s disease is not known, there is evidence to suggest that genetics plays the most important role. In addition to a family history, there are a number of other factors believed to contribute to the development or worsening of the condition. These include:

  • Gender. Men are more likely to develop Dupuytren’s than women.
  • Ancestry. People of northern European (English, Scottish, Irish, Dutch and French) and Scandinavian (Norwegian, Swedish, Danish and Finnish) descent are more at risk of developing the condition.
  • Alcohol use may be a risk factor for developing and worsening Dupuytren’s.
  • Smoking is believed to increase the risk of Dupuytren’s.
  • Certain medical conditions such as seizure disorders and diabetes are more prone to developing Dupuytren’s.
  • Age. It generally develops between the ages of forty and sixty and is unusual before the age of 40. It is more severe if it starts at a younger age and the incidence increases with age.

What are the Treatments for Dupuytren’s?

There is currently no medical treatment for Dupuytren’s. Only the consequences of Dupuytrens (the bend or contracture) can be treated. Treatment is recommended when the inability to straighten the finger causes difficulty with function.
Traditionally, Dupuytren’s treatment has been surgery which includes removal of the abnormal tissue, allowing the fingers to straighten. It is impossible to remove all of the diseased tissue. The disease may come back or extend beyond the original area even after surgery. Although usually effective, open Dupuytrens’ surgery may require wound care and can also lead to joint stiffness

There is a minimally-invasive alternative to surgery. This is known as needle aponeurotomy. Needle aponeurotomy only uses local anesthesia. It involves cutting contracted fibers beneath the skin with the tip of a small needle. The goal is to cut the ‘cord’ of abnormal tissue, resulting in straighter fingers. This is a less invasive alternative than full surgery. There are many advantages to needle aponeurotomy. A recent study has shown that needle aponeurotomy is an effective, long lasting, and safe Dupuytren’s contracture treatment. Like any procedure for Dupuytren’s, there is a chance of recurrence and need for further treatment. The procedure is affordable and convenient- often able to be done in the office.

Another option is Xiaflex, a collagenase-based medication that is injected into the Dupuytrens’ material in the hand. The hand is then manipulated to correct the contracture. At Florida Hand Center we have not found this to be a desirable option at this time due to the medication being very expensive and the manipulation can be painful and there are two separate visits required. The treatment has not been shown to be more effective than Needle aponeurotomy and the recurrence rates are essentially the same for both treatments.