Dupuytren’s contracture

Anatomy

The fascia is a layer of tissue that helps to anchor and stabilize the skin on the palm side of the hand. Without the fascia, the skin on your palm would be as loose and moveable as the skin on the back of your hand.

About

Dupuytren’s disease (or Dupuytren’s contracture) is a condition that affects the fibrous layer of tissue that lies underneath the skin in the palm and fingers. It causes this part of the hand to thicken and tighten over time, pulling the fingers inward toward the palm. This bending or pulling is called a Dupuytren’s contracture. Although the cords in the palm may look like tendons, the tendons are not involved in Dupuytren’s.

Dupuytren’s disease progresses very slowly over several years and may remain mild enough such that no treatment is needed. As the disease progresses, it may result in the fingers becoming stuck permanently in the contracted position.

The cause of Dupuytren’s disease is not known, but most evidence points towards genetics as having the most important role.

There are several risk factors that may contribute to the development or worsening of Dupuytren’s disease, including:

• Gender – Men are more likely to develop the condition than women
• Ancestry – People of northern European (English, Irish, Scottish, French, and Dutch) and Scandinavian (Swedish, Norwegian, and Finnish) ancestry are more likely to develop the condition
• Tobacco use
• Certain medical conditions such as diabetes and seizure disorders
• Age
• Trauma to the hand

Symptoms

Dupuytren’s disease typically progresses very slowly over several years. As the disease progresses, there are several symptoms you may notice. These symptoms include:

• Nodules – You may develop one or several small lumps, or nodules, in the palm of your hand fixed to the overlying skin. At first, the nodules may feel tender, but over time the tenderness will usually go away. In some instances, there may be a deep indentation in the skin near one or all your nodules.
• Cords – Your nodules may thicken and contract, which contributes to the formation of dense and tough cords of tissue under the skin. When this happens, it can restrict or tether the fingers and thumb, preventing them from straightening or from spreading apart.
• Contractures – As the tissue or cords under the skin continue to tighten, your fingers may be pulled toward your palm and may be restricted from spreading apart. The ring finger and little finger are usually the main ones to be affected. As your fingers continue to become constricted, it may be hard to complete daily tasks such as putting your hands in your pocket and grasping large objects.

Diagnosis

Your Florida Orthopaedic Institute physician will take a look at your medical history, overall health, and symptoms. After, they will perform a physical examination, which will include:

• Test the feeling in your fingers
• Record the location of the nodules and cords in your palm
• Measure the range of motion of your fingers
• Document the appearance of your hand with clinical photographs, depending on the severity of your Dupuytren’s disease

Treatment

Unfortunately, there is no cure now for Dupuytren’s disease. But the condition is not life threatening and not dangerous. At first, the disease may not even be noticeable and may also not interfere with daily activities, so you may not need treatments of any kind.

If the condition progresses, your physician may first recommend nonsurgical treatments to help slow the disease. Only after nonsurgical treatments will your physician recommend surgery.

Nonsurgical treatments

Steroid injections are the primary nonsurgical treatment available for Dupuytren’s disease regarding pain. Powerful anti-inflammatory medications can be injected into a painful nodule which may slow the progression of your finger contracture.

Xiaflex – a new medicine for nonsurgical treatment

Xiaflex is a relatively new, FDA-approved, non-surgical treatment for adults with Dupuytren’s contracture when a “cord” is felt. Xiaflex starts breaking down the “cord” immediately after the first injection.

The hand and wrist specialists at Florida Orthopaedic Institute are experienced in Xiaflex injection procedures of the hand, and in treating people with Dupuytren’s contracture. They have been specially trained to administer the shots during an office visit, with no general anesthesia required.

Studies have shown that prescription Xiaflex, along with an after-treatment finger extension exercise regiment, can help straighten or nearly straighten the affected finger and improve range of motion.

(XIAFLEX is a registered trademark of Endo International plc or one of its affiliates.)

Surgical treatments

If your Dupuytren’s disease progresses to the point where you cannot complete daily tasks, surgery may be considered. The goal of surgery is to reduce the amount of finger contractions and improve motion in the affected fingers. These procedures do not cure Dupuytren’s disease, but they can help set back the clock. Unfortunately, the healing tissues that form have the same potential to develop cords in the future—but the gains in hand function can still be substantial.

Fasciotomy is one of the procedures used. It involves dividing the thickened cords of tissue. Although the cord itself is not removed, dividing it helps decrease the contracture and increase the movement of the affected finger.

Subtotal palmar fasciectomy is another procedure that removes as much of the abnormal tissue and cords as possible to help straighten your fingers.

Severe problems are uncommon after surgery, but you should expect some pain, stiffness, and swelling.

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