Dupuytren’s contracture of the hand

One of the more uncommon conditions of the hands and fingers is Dupuytren’s contracture (also called Dupuytren’s disease). This causes one or more fingers to become curled, which can make it difficult to pick up or hold objects or perform daily activities.

Legend says the condition originated with the Vikings of Northern Europe, although this is debated. It was later named after 19th-century French surgeon Guillaume Dupuytren, who performed the first successful surgery for the condition. Fast forward to the 21st century, and Dupuytren’s contracture now affects approximately one in twenty Americans.

What is Dupuytren’s contracture?

Fascia is a layer of fibrous tissue under the skin of the fingers and palm. Dupuytren’s contracture is a thickening and shortening of this tissue.

This thickened area starts as a hard lump called a lump. Over years to decades, it can develop into a thick band called a cord, which causes one or more fingers to curl toward the palm and become stuck in a bent position. This can make it difficult to grasp objects, button clothes, use a computer, or perform other daily tasks.

The condition does not always get worse. It can be stable for years or even improve in some people.

Which fingers are most likely to be affected?

The ring and pinky fingers are most often affected. But the condition can affect all fingers and thumb.

“In about half of cases, the condition can affect both hands,” says Dr. Phillip Blazar, orthopedic surgeon and division chief of Hand and Upper Extremity at Harvard-affiliated Brigham and Women’s Hospital. Fortunately, it rarely causes pain.

What causes Dupuytren’s contracture?

The cause is currently unclear. Still, several factors can increase a person’s risk, such as:

• Genetics: This condition is more common in people of Northern European, British or Scandinavian descent.
• Sex: Men are affected more often than women.
• Age: The condition often occurs after the age of 50.
• Family history of the disease.

People with diabetes and seizures are also more likely to develop Dupuytren’s disease. The condition may occur and/or worsen after trauma to the hand.

How is Dupuytren’s contracture treated?

Although there is no cure, treatments and occupational or physical therapy can help address symptoms and improve finger mobility. “Many people with mild cases of Dupuytren’s disease find that it has little impact on their ability to use their hands,” says Dr. Blazar.

However, moderate or severe cases can disrupt hand function. It is possible to restore normal finger movement with non-surgical treatments, such as:

• Collagenase injection. This procedure is performed in the doctor’s office. An enzyme called collagenase is injected into the cords of your hand, which breaks down and dissolves the thickened tissue. At a follow-up visit, your doctor will give you a local anesthetic and then cut the cords by manipulating and stretching your fingers in the direction in which they cannot move.
• Needle aponeurotomy. This in-office procedure involves passing a hypodermic needle back and forth through the restrictive cords to weaken and break them.

“Your hand surgeon will discuss both treatment options to determine which is best for your situation,” says Dr. Blazer. “There are also some variations in the anatomy of the disease that may make one treatment or the other less beneficial for a particular person or finger.” Both treatments do not remove the cords and the condition may return and require additional treatment.

What about surgical treatment?

If non-surgical treatment does not relieve symptoms or you have a serious condition, surgery may be recommended. Surgical approaches include:

• Fasciotomy. An incision is made in your palm to distribute the thickened tissue in the umbilical cord.
• Subtotal palmar fasciectomy. A zigzag incision is made along the folds in the hand to remove the abnormal tissue and umbilical cord. Occasionally, a skin graft may be needed to help the wound heal.

During recovery, you will wear a splint on the repaired hand. People should expect some pain, stiffness, and swelling afterward. The duration of recovery varies per individual, as does how many fingers were operated on and which ones.

“Most people largely recover after three months, but some may not feel fully recovered for a while,” says Dr. Blazer. Hand therapists can also help with strength and flexibility exercises to speed recovery.

Most people’s fingers move better after surgery. However, as with non-surgical treatments, the contracture can return, so some people may need additional surgery later.