WHAT IS IT?
Dupuytren's contracture is an abnormal thickening of tough tissue in the palm and fingers that can cause the fingers to curl. It is more common in men than in women and becomes more common as we grow older. It can also lead to painful nodules in the palm, as well.
The cause of Dupuytren's contracture is not known. It is not caused by an injury. It is not a cancer. It is most common in people of Northern European descent.
Dupuytren's contracture usually occurs very gradually. It may begin as a small tender lump in the palm. Over time the pain usually goes away, but tough bands may form that cause the fingers to bend toward the palm. The ring and small fingers are most commonly affected.
- The process is not malignant.
- The disease may progress slowly, or it may have periods of temporary arrest or rapid progression.
- Involvement of the feet may be associated in 15-20% of cases. Other body parts may also be affected.
- Involvement of the disease in both hands is common.
- Flexion contractures usually occur at either of the first two finger joints.
- Flexor tendons are never involved in this process.
- Skin may be involved by the infiltration of dermal layers with the disease.
- Recurrence is frequent, particularly at the proximal interphalangeal joints.
There is no way to stop or cure the problem. It is not dangerous. Dupuytren's contracture usually progresses very slowly and may not be troublesome for years. If a painful lump is present, an injection may help diminish the pain. If the fingers become bent, they may interfere with use of your hand. Intervention is recommended when inability to straighten the fingers significantly limits your hand function.
Historically, subtotal palmar fasciectomy is the surgical removal of the taut, retracted palmar fascia from the palm and afflicted finger(s). The amount of time spent during the operation depends on the amount of involvement, but generally requires around one hour, and is done as an outpatient in surgery.
Over the past few years, injections have come on the market which dissolve the cords without the need for surgery. Early data shows that in many cases it does as well as surgery for relief of symptoms and long-lasting results. Every patient is different, and the treatment needs to be tailored to the specific clinical situation.