Dupuytren’s Contracture: A Functional Loss of Hand Motion
Dupuytren’s contracture is an abnormal thickening of fibrous tissue underneath the skin of the palm and fingers. This thickening of tissue can cause the fingers to curl and is most commonly found in the 4th and 5th fingers of the hand. This condition is also more common in males than females and in people of northern European descent. The cause of Dupuytren’s is unknown, but there is a hereditary component along with other factors such as heavy smoking and alcohol use, diabetes, seizure disorders, and thyroid problems. It is also more commonly seen in the older population and can also develop in both hands.
Dupuytren’s contracture usually starts very slowly with a small nodule in the palm of the hand that may be tender, but the tenderness will go away in time. The nodules begin to thicken and contract, which will cause one or more fingers to bend toward the palm of the hand. As these contractures increase, it may be difficult to use the affected fingers to grasp objects. Progression of this condition is unpredictable. Some individuals will have only small lumps or cords while others will develop severely bent fingers. More severe disease often occurs with an earlier age of onset.
Treatment of Dupuytren’s contracture depends on the severity and the underlying condition of the affected individual. Treatments include stretching, heat, ultrasound, local cortisone injection, and surgical procedures. Various surgical techniques are available in order to correct finger position. The goal of surgery is to improve finger position and thereby hand function. Despite surgery, the condition may recur and the fingers may begin to bend into the palm once again. There is new research on the horizon to treat Dupuytren’s contracture. Experiments are being performed with enzyme injections that may be able to break down the tough bands and improve motion without surgery. Early results are promising, but these injections are not available for general use at this time.