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Dupuytren’s contracture, or Dupuytren’s disease, is a systemic disorder that results in the deformity of one or both hands. It typically affects men, people over age 40 and those of Scandinavian and Northern European descent. The cause is unknown, and no advances have been made to prevent the hand disease.
By definition a contracture occurs when the normally elastic tissue of various parts of the body—in this case, the hands—is replaced by stiff, hard, nonelastic tissue, preventing normal movement and function. Signs of Dupuytren’s contracture include firm lumps of tissue (nodules) forming in the palm of the hand, sticking to the inside of the skin. You may also see pits, or depressions in the palm, form as the diseased tissue pulls on the overlying skin. Thick cords, or lines of tissue, may extend from the palm to the fingers as the disease progresses. While not typically painful, the cords and bumps can cause the fingers (usually the ring and small fingers) to bend into the palm of the hand, making it difficult to wash your hands, put your hands in your pockets and wear gloves in cold weather—anything that requires your fingers to be straight.
While Dupuytren’s can’t be prevented, there are treatments that can help straighten out the fingers. Treatments fall into one of two groups: minimally invasive and surgical.
Surgical treatments
The most common procedure currently performed is fasciectomy. Your surgeon first numbs your hand with a local anesthetic, then makes cuts to remove the diseased tissue from underneath the skin of the palm and fingers. The wound may be left open to heal gradually, or it may be closed with a skin graft, called a dermofasciectomy. You may need to wear a splint during the recovery period.
Another surgical option is a fasciotomy. With this procedure, your hand is numbed and the diseased tissue is released with a cut. The surgeon then leaves the incision open to heal on its own. You’ll need to wear a splint after this procedure.
Physical therapy is typically recommended following surgery.
Minimally invasive treatments
Other procedures don’t require cuts to the skin to release the tight tissue that gnarls the hands. These include:
- Needle aponeurotomy, in which the tip of a small hypodermic needle is used to puncture the cord beneath the skin.
- Collagenase enzyme injections, which are targeted to the cords to weaken the tissue. This is the second most common procedure used in the US to treat Dupuytren’s contracture.
Once these procedures are completed, the surgeon pulls on each of the affected fingers in an effort to rupture the thick cords and straighten out the fingers.
Hand splinting is often recommended after treatment, although the actual benefit is unknown. There are a variety of mechanical splints, with the most common being static splints. Others include static progressive splints and tension-free splinting, used after surgery.
These treatments may partially or completely improve the deformity. While the improvements may last for years, it’s not unusual for contractures to develop a second time, either in the original site or in a new area.
Which treatment is best?
There are pros and cons to each type of procedure. An advantage of surgical treatment is that the improvement lasts, on average, over twice as long as minimally invasive ones do. On the other hand, surgery requires longer recovery time and has higher rates of complication.
Other therapy
Another option is cortisone injections. While these injections don’t relieve the hardened tissue of the contracture and straighten the fingers, they are believed to help slow progression of the disease and relieve tenderness.
Your hand surgeon can help you weigh the options based on the stage of the disease and the joints involved. The goal of treatment is to improve the range of motion and function as much as possible, even though you may not be able to completely straighten the fingers affected by the disease.
