A different kind of palm reading: What to know about Dupuytren's contracture
Written in association with:If you are struggling with your fingers bending in and stubbornly refusing to budge, it’s not that they’re mutinous nor developing a mind of their own. You might be dealing with Dupuytren’s contracture, a chronic condition that causes the fingers to freeze in place. Leading consultant orthopaedic surgeon Miss Sally-Anne Phillips breaks down how the condition occurs and the options for treatment.
What is Dupuytren’s contracture?
Dupuytren’s contracture is a condition of the hand where the fibrous tissue called the palmar fascia that sits under the palm begins to grow hard lumps and toughen in texture, which can be felt on the surface of the skin. The palmar fascia is the anchor point for the tendons of the hand, helping them stay in place, but when the lumps grow bigger and start to form cords that tighten, this causes our fingers to permanently curl inwards, obstructing the use of our fingers and other flexible parts of the hand. The little and ring fingers tend to be the most affected, but it can occur in all of the fingers.
What causes Dupuytren’s contracture?
There are no proven causes for Dupuytren’s contracture, but it is known to be passed down genetically. There are higher instances of this condition in men of European descent, and it is most common in older people.
The condition will worsen over time, and leave the fingers frozen in bent and crooked positions. It would be very difficult to straighten the fingers in the advanced stages, even with the use of force and splints.
Although this condition is not life-threatening or painful, it can severely disrupt daily life and thus impact your mental well-being. Everyday activities such as driving, writing or drawing, typing, putting on gloves, washing the face, and getting dressed may eventually be impossible without assistance.
How can Dupuytren’s contracture be treated?
There is no cure to this disease, and treatment can only aim to improve the fuction of the fingers. If noticed in the earliest stages where the finger is only slightly bent, a full correction may be obtained with a local anaesthetic procedure called a needle fasciotomy, where a needle is used to divide the tissue and the finger, which is then manipulated to straighten it. For more extreme cases, then surgery will only improve the positioning of the fingers but may not be able to straighten them completely. This is called Dupuytren’s fasciectomy, where the thickened cords of tissue are removed via an incision to the palm or finger.
Surgical treatment is however temporary, as it will not stop the hardening of the palmar fascia and there is a 30 per cent chance that the fingers may start to curl in again within two years after the surgery. For reoccurrences, a similar surgery can be conducted called a demo fasciectomy, where the Dupuytren's cords and skin are replaced with a skin graft. But note that this procedure cannot guarantee that the condition won’t reappear.
An alternative treatment was collagenase, which was injected into the thickened tissue to break up the cords and allow them to be stretched, releasing the fingers from their long-held position. Unfortunately, this treatment is no longer available in the UK and Europe.
If you have concerns about the condition of your fingers, hands, or wrists, Miss Sally-Anne Phillips specialises in those areas and is available for consultation via her Top Doctors profile.
