Dupuytren's Contracture

Dupuytren’s Contracture is a hand condition where thickening of the underlying fibrous tissues of the palm cause the fingers to bend inward. Patients with this condition are unable to fully straighten the affected fingers.

It commonly occurs in the ring finger and little finger. Occasionally the middle finger is affected but the thumb and index finger are rarely affected. Dupuytren’s contracture is a condition that usually progresses slowly over many years and is not usually painful. However, some cases may progress rapidly and be painful to the patient.

Symptoms

The most commonly observed symptoms of Dupuytren's contracture are lumps or nodules in the palm of the hand, difficulty in straightening the fingers, and contracture of the nodules which form tough bands under the skin and will prevent the fingers from straightening.

Causes and risk factors

The cause of Dupuytren’s contracture is unknown. However, there are certain risk factors that may increase your chance of developing the condition. These can include the following:

• Age: It occurs more frequently around from 50 – 70 years of age. If it occurs earlier it tends to be more severe.
• Social Habits: Smoking and drinking alcohol may increase your risk of developing the condition.
• Medical Conditions: Patients with diabetes, alcoholism, cirrhosis of the liver, and seizure disorders appear to be at increased risk of developing the condition.
• Gender: The condition is more common in males.
• Heredity: The condition tends to run in families.
• Ancestry: Most commonly affected are northern Europeans and people of Scandinavian descent. For this reason it is sometimes called the “Viking’s Disease”.

Diagnosis

Dupuytren's contracture is diagnosed based on the patient's history and physical examination without any special tests required. The physical examination may involve pressing on different parts of your hands and fingers to assess for hardened knots or tough bands of tissue.

Treatment

You may not need treatment for Dupuytren’s contracture if the condition is in the early stages and not affecting your ability to perform daily activities. However, if you are experiencing pain or are having difficulty using your hands for everyday activities, Professor Bain will recommend conservative treatment options to treat your condition. Treatment options will vary depending on the severity of the condition. The conservative approaches include:

• Massage Exercises: Stretching exercises such as bending the fingers away from the palm may provide some comfort, but unlikely to change the natural history.
• Injections: Steroid injections in the palm may be done to relieve local inflammation. However this is rarely required.
• Collagenase Injection: An enzymatic drug that breaks down collagen can be injected into the corded tissue to soften and weaken the contracture. The Surgeon will later that week manipulate the area manually to break up the tissue.
• Needle Aponeurotomy: This procedure involves inserting a small needle into the thickened palm to release the tissue. The finger may be manipulated to loosen and break up the contracting tissue.

Surgical Procedure

If conservative treatment options fail to resolve the condition and symptoms persist and your quality of life is adversely affected, Professor Bain may recommend a surgical procedure to release the thickened tissue.

This surgery is usually performed in an operating room under local or regional anaesthesia on an outpatient basis as a day surgery. Incisions are made over the affected palm area.

The surgeon then removes the thickened fibrous tissue causing the contracture.

The incision is then closed with sutures and covered with a sterile dressing.

Complications

Complications can be medical (general) or specific to hand surgery. Medical complications include those of the anaesthetic and your general well-being. Complications associated with hand surgery include:

• Infection
• Nerve damage causing weakness, paralysis, or loss of feeling in the hand area
• Injury to the arteries of the fingers/hand
• Recurrence of the condition