How to recognise signs of Dupuytren’s contracture

If you have noticed lumps under the skin in the palm of your hand which feels tender and sore, you may be experiencing a condition called Dupuytren’s contracture (or Dupuytren’s disease). It is especially obvious if at least one of your fingers bend in towards your palm. We spoke to orthopaedic surgeon Mr Andrew Logan about how it occurs, the signs and how the condition compares to trigger finger.
 

Can you explain how Dupuytren’s contracture occurs?

The palm of the hand has a layer of skin. Underneath that layer of skin is a sheet of fibrous tissue. This sheet of fibrous tissue anchors the skin to the deeper structures in the hand. This means that when you grip an object the skin does not move.

In Dupuytren’s contracture, parts of the fibrous sheet thicken and form lumps known as nodules in the palm. These nodules can increase in size forming chords. When formed, the chords can shorten and pull the finger down.
 

What are the signs of Dupuytren’s contracture?

A patient will first notice a firm lump appearing in the palm. It is most commonly in line with the ring or little finger.

As the condition progresses these firm lumps become longer and spread down into the finger. The cord that is formed is often mistaken for a tendon just under the skin whereas, in fact, it is a longitudinal thickening of part of the fibrous sheet.

As the tendon shortens, the finger is progressively pulled into a bent position and it is not possible to fully straighten it.
 

What is the difference between trigger finger and Dupuytren’s contracture?

Trigger finger is where the tendon catches on the entrance of the tunnel that the tendon runs in. This can cause the finger to get temporarily stuck in a bent position but it is possible to straighten the finger, usually with a painful click. Trigger finger is often sudden in onset.

With Dupuytren’s the fibrous cord that is pulling down the finger forms over a period of time. Therefore the bend in the finger slowly worsens. It is also not possible to straighten the finger as the cord is solid and stiff.
 

What causes Dupuytren’s contracture?

There are no known proven external causes for this condition. It is a genetic condition which means that it runs in the family. For many years it was believed that the condition came from the Vikings. This has recently been proven not to be the case.

A patient will often know a family member with this condition. However, the exact type of inheritance pattern is not known and the condition can skip generations.
 

What are the treatment options?

If there are just chords and nodules but the finger is straight then it is generally left alone. Once the finger starts to bend and cannot be straightened then it is worth considering surgical treatment. There are different types of surgical treatment depending on the severity and pattern of the individual’s disease.
 

• Radiotherapy - This is controversial. Most hand surgeons would not recommend this. 
• Breaking the cord (fasciotomy) - This can either be done with a needle in the clinic or by surgically removing a section of the cord 
• Removing the whole cord (fasciectomy) - This is where the cord is removed with an operation 
• Removing the whole cord and replacing some of the skin with a skin graft (Demo fasciectomy) - This is used for severe primary disease or for patients where the disease has recurred following surgery.

What can I expect with the results from treatment?

When the finger is only slightly bent it is often possible to get a full correction with an operation. With fingers that are very bent an operation will improve the position but in most cases does not get the finger fully straight.

The treatment does not cure this condition. Even if all the diseased tissue is removed at operation it will come back given enough time. In some patients, it can come back quite quickly, within two to three years. 

You can book an appointment to see Mr Logan at the Spire Cardiff Hospital via his Top Doctor’s profile here. Alternatively, you can talk to him via video call using our e-Consultation tool, which can also be found on his profile.