Dupuytren’s contracture

What is Dupuytren's contracture?

Dupuytren's contracture, or Dupuytren's disease, is a hand deformity that consists of the thickening of tissues located under the palm of the hand and results in one or more of the fingers becoming permanently bent in a flexed position.

When the syndrome starts, knots or lumps form in the palm that prevent the fingers from straightening. Daily activities, such as handshaking or putting your hand in your pocket, can be complicated.

This condition typically affects the ring finger and the little finger and can get slowly worse over many months or years. It is more prevalent in older men originating in Northern Europe.

Dupuytren's contracture can be treated by an orthopaedic surgeon, specialising in hand and wrist conditions. 

Symptoms of Dupuytren's contracture

The first symptom of Dupuytren's contracture is the appearance of a hard (callus-like) nodule in the palm that can bother you but typically doesn’t cause any pain.

In the later stages of Dupuytren's contracture, tissue cords form under the skin on the palm that can extend to the fingers. As these cords contract, the fingers bend closer to the palm.

The ring finger and little finger are usually the most affected, but the middle finger may also be involved. Rarely, the index finger and thumb are affected. Both hands are susceptible to Dupuytren's contracture but generally, one of them is more severe than the other.

This disease generally progresses slowly over many years.

How is Dupuytren's contracture treated?

Surgical treatment can usually restore normal finger movement. The disease does recur after surgery in up to half of cases after ten years.

If the condition is left untreated, it will progress until the hand cannot be fully opened.

Medical tests for Dupuytren's contracture

Most of the time, a specialist will perform a physical examination to make a diagnosis. To complete the diagnosis, the specialist might ask you to perform a series of exercises such as placing the hand open on a table or flat surface to see if you can fully stretch your fingers.

What causes Dupuytren's contracture?

The cause of Dupuytren's contracture is unknown, but it could be associated with certain biochemical factors within the affected tissue. Knowing the risk factors can allow for early detection and treatment.

Factors that increase the risk of developing this condition include:

Age - occurs more frequently after the age of 40. Sex - men are more likely to develop Dupuytren’s contracture than women. Genetics - people of Northern European descent are at increased risk of developing the condition. Family history - Dupuytren's contracture is often hereditary. Tobacco and alcohol use - Smoking is associated with an increased risk of Dupuytren's contracture, perhaps due to microscopic changes in smoking caused by blood vessels. Alcohol consumption is also associated with Dupuytren's contracture. Diabetes - people with diabetes have been reported to be at increased risk of developing Dupuytren's contracture.

Treatments for Dupuytren's contracture

Physiotherapy can be used to restore the function of the hand and gain strength and mobility.

Dupuytren’s treatment may consist of the following:

Surgery is an option for people with an advanced condition, who have limited function, or where the disease is progressing. The goal is to surgically remove the affected palm tissue. Radiotherapy can be used to irradiate any nodules and cords associated with Dupuytren’s. An experimental technique based on using collagenase injections.

Which specialist treats you?

The specialist that treats this condition is typically an orthopaedic surgeon. An orthopaedic surgeon treats fractures or injuries to bones, muscles, joints and ligaments.