Dupuytren’s Contracture

Dupuytren’s contracture is a disorder of the palm of the hand and fingers. In the normal hand there is a fibrous tissue called fascia. Fascia covers the important nerves, blood vessels, muscles, and tendons. Fascia also stabilizes the skin. In Dupuytren’s disease, this fascia can become abnormal. It becomes thicker, forming cords. These cords are often mistaken for a tendon because they look and feel similar. Unlike a tendon that is moved by a muscle that shortens and lengthens, cord tissue is not connected to a muscle. Cord tissue is static and does not move. There may be a single cord or several. Cords can be separate or connected.

Most people with Dupuytren’s contracture will also have nodules or bumps in the hand. When they are first noticed, these nodules and cords may not change for a long time. They can also have a slow or fast change. Cords and nodules may become bigger and thicker over time. They may begin to pull the fingers into a bent (flexed) position so the fingers are bent toward the palm.

The exact cause of Dupuytren’s contracture is unknown and very complex. It is a hereditary disease. This means family history and ancestry play a role. The problem is more common in men, people over age 40, and people of Northern European descent. It is less common in African and Middle Eastern descent. Smoking, diabetes, alcohol, lower body mass index, and aging are also all related to Dupuytren’s.

There is no evidence that hand injuries or specific jobs lead to a higher risk of developing Dupuytren’s contracture. There may be a mild relationship to trauma in someone who is at risk. Occasionally after a distal radius (wrist) fracture, a patient may develop a single nodule in the palm. This nodule may or may not be tender. It often does not progress to result in a bent finger joint.

• The thickening and contracture usually develops slowly. Some people develop nodules in the palm which may be painful though this is uncommon. The nodules can develop into more significant bands (cords) that sometimes can be mistaken for contracted  tendons. These then progressively pull the fingers into the palm. The ring and little fingers are the most commonly affected and can bend all the way down to touch the palm in severe cases. Functionally, patients may find difficulty with getting hands into pockets, poking self in the eye when washing face.
• Patients are unable to place hand flat on a table “table top test”.

• Percutaneous Fasciotomy: In majority of cases patients are allowed to immediately use and wet their hands.
• Traditional Fasciectomy : Patients are advised to wear the bandage until the sutures are removed to 14 days after surgery. They are not allowed to wet their hands until that time. Use of hand is limited for 4-6 weeks.