Dupuytrens Contracture

Dupuytren's contracture is a painless thickening and contracture of tissue beneath the skin on the palm of the hand and fingers. Progressive contracture may result in deformity and loss of function of the hand.

The cause of this contracture is unknown, but minor trauma and genetic predisposition may play a role. One or both hands may be affected and the ring finger is affected most often, followed by the little, middle, and index fingers.

A small, painless nodule develops in the connective tissue and eventually develops into a cord-like band. Extension of the fingers becomes difficult or even impossible with advanced cases.

The condition becomes more common after the age of 40, and men are affected more often than women.

SYMPTOMS

  • Painless nodule in the palm, developing into a cord-like band
  • Thickening of the lines in the palms of the hands
  • Extending the fingers is difficult - the fourth and fifth fingers curl up and are unable to be easily straightened (contracture)

SURGERY

The thickened contracted tissue is removed, releasing the joint. In very severe or recurrent cases, skin grafts may be required. Simple division of a fibrous cord in the palm is sometimes used alone to release isolated contracture of a knuckle joint. Incisions in the fingers are always stitched. Those in the palm are also usually closed, but some surgeons may leave these wounds open to heal. A protective plaster of paris splint is sometimes used. During the first 48 hours the hand is elevated to prevent swelling and to decrease pain.

FOLLOWING SURGERY

You will need hand exercises which will be supervised by a physiotherapist following discharge from hospital. If one of your fingers was very contracted prior to surgery, then splints to keep the fingers straight are usually used. This type of splint is worn continuously initially and then at night to maintain the corrected position. It may continue to be worn at night for several months. In general, full release of the knuckle joint is achieved and maintained. The final result in finger joints depends on the degree of contracture present before surgery. If this is severe, it may amount to a 50 to 75% correction only.

When you are able to return to work will depend on your occupation and whether the dominant hand was operated upon. In general, clerical work can be resumed after 2 to 4 weeks and manual work rather later at 4 to 6 weeks. Regular stretching helps to keep the fingers straight.

The condition can return following surgery or may extend from the original area. This is more likely if the initial contracture developed rapidly in a young person. The need for an operation following recurrence is assessed in a similar way to new cases. Skin grafting is more likely to be required following recurrence. After surgery, full movement of the fingers must be kept up.

If not treated, the disease may develop so slowly that no treatment is necessary. It may, however, produce marked contracture of the fingers. The fingertips then become fixed in the palm, limiting function and causing skin problems.