Dupuytren’s contracture: Your guide to symptoms and care

Dupuytren’s contracture is a condition that affects the hands, causing the fingers to bend towards the palm and making it difficult to straighten them. It develops gradually and is most common in older adults, particularly men. While Dupuytren’s contracture is not usually painful, it can limit hand movement and interfere with daily tasks.

Leading consultant hand and wrist surgeon Mr Ali Shafighian answers common questions from symptoms to treatment options, providing essential information for those wanting to learn more about the condition.

What is Dupuytren’s contracture?

Dupuytren’s contracture is a condition affecting the connective tissue under the skin of the palm, leading to the fingers becoming permanently bent. The tissue thickens and forms lumps or nodules, which can gradually pull one or more fingers towards the palm. Over time, this can limit hand function and make simple tasks like gripping objects difficult. It is a relatively common condition, particularly among older adults, though not everyone with the condition will develop severe symptoms.

Who is at risk for Dupuytren’s contracture?

The exact cause of Dupuytren's contracture is still unclear, but it appears to have a genetic link. People of Northern European descent are more commonly affected, especially men over the age of 50. Other risk factors include a family history of the condition, smoking, alcohol consumption, and conditions such as diabetes. It is important to note that while these factors increase the likelihood of developing Dupuytren’s contracture, they do not guarantee it will occur.

What are the symptoms of Dupuytren's contracture?

In the early stages, the condition may present as small lumps or nodules in the palm, usually near the base of the fingers. These nodules may feel hard and may cause mild discomfort, but this is not always the case. Over time, these lumps can form thick cords of tissue, which can pull the fingers into a bent position, a process known as "contracture." The ring and little fingers are most commonly affected, though it can involve any of the fingers. Once the fingers are bent, it becomes challenging to straighten them, making everyday tasks harder.

Does Dupuytren’s contracture cause pain?

In most cases, Dupuytren’s contracture is not painful. While some patients may experience tenderness or discomfort around the nodules in the palm, the condition is more often characterised by a gradual loss of hand function rather than pain. However, pain can occur in some individuals, particularly in the early stages of the disease. If pain is present, it is usually mild and tends to subside as the condition progresses.

How is Dupuytren’s contracture diagnosed?

A doctor can often diagnose Dupuytren’s contracture through a simple physical examination. They will check for the presence of lumps, cords, and finger contractures in the hand. The doctor may ask you to perform certain movements with your hand to assess the range of motion and determine how much the condition is affecting your fingers. Additional tests, such as imaging scans, are not typically required for diagnosis.

What treatments are available for Dupuytren’s contracture?

There are various treatment options available for Dupuytren's contracture, depending on the severity of the condition. In mild cases where hand function is not significantly affected, no treatment may be necessary. However, when the contracture begins to interfere with daily activities, interventions such as injections or surgery may be recommended.

Non-surgical treatments: Injections of a medication known as collagenase can help break down the thickened tissue, making it easier to straighten the fingers. However, unfortunately this is not currently available outside of the USA. Another option is needle aponeurotomy, where a needle is used to break the cords of tissue under the skin.

Surgical treatment: In more advanced cases, surgery may be needed to remove or release the affected tissue, allowing the fingers to straighten. The most common procedure is called a fasciectomy, where the surgeon removes the thickened bands of tissue. Recovery from surgery can take several weeks, and physiotherapy may be recommended to restore hand function.

Can Dupuytren’s contracture come back after treatment?

Yes, Dupuytren's contracture can recur even after successful treatment. This is because the underlying cause of the condition, a change in the connective tissue, remains. Recurrence is more common in patients who develop the condition at a younger age or have severe contractures. Regular monitoring and follow-up with a surgeon can help manage the condition if it returns.

Can Dupuytren’s contracture be prevented?

There is currently no known way to prevent Dupuytren’s contracture, especially if you are genetically predisposed to the condition. However, avoiding risk factors such as smoking and heavy alcohol consumption may help reduce the chances of developing it. Maintaining general hand health through stretching and exercises may also help keep the hands flexible, although it is unlikely to stop the disease from progressing entirely.

If you are suffering from Dupuytren’s contracture and would like to book a consultation with Mr Shafighian, simply visit his Top Doctors profile today.