Dupuytren’s contracture is a common disorder in which fibrous tissue proliferates in the palm of the hand and attaches to the tendon sheaths, pulling the fingers into the palm of the hand.

The fingers bend towards the hand and cannot be completely stretched out.

The fibrous tissue feels like thickened cords in the palm of the hand. The fourth and fifth digits, which are the ring finger and the pinky, are the most commonly affected, but any of the fingers may be involved, including the thumb.

Dupuytren’s contracture is also known as morbus Dupuytren, Dupuytren’s disease, or palmar fibromatosis.

Well-known public figures with Dupuytren’s contracture include the late former President of the United States, Ronald Reagan, the pianist Misha Dichter, and the United Kingdom’s Prime Minister Margaret Thatcher.

Symptoms

A contracture is an abnormal shortening of tissue, which makes it hard to stretch.


Dupuyten’s contracture can lead to deformities of the fingers.

Dupuytren’s contracture is a shortening of the thin, tough, layer of fibrous tissue between the skin of the palm, known as the palmar aponeurosis, or palmar fascia, and the underlying flexor tendons of the fingers.

Symptoms develop gradually. The first sign might be a tender lump in the palm of the hand. There may be pain at first, but this usually goes away.

Tough bands of tissue may develop, and it becomes harder to stretch the hand. The bands may look like a small callus, which is an especially hard area of skin.

Unusual dimples or lumps may appear in the palm, and the skin may pucker over the lumps.

The fingers cannot be fully straightened out.

In about half of all cases, both hands are affected. Toes may be affected, but this is very rare.

The condition is not usually painful, but the individual may find it harder to use the affected fingers. The contracture ranges from mild to severe.

Causes

The exact cause is unknown, but research in 2006 suggested a “high genetic basis” for the condition. This was supported by findings from genomic studies published in 2012.

Risk factors

Dupuytren’s contracture commonly affects people in middle age and older, but it can happen to people during their twenties.

After the age of 40 years, men have a higher risk than women of developing the condition. After the age of 80 years, the risk is about the same for men and women.

Men are more than three times more likely to develop Dupuytren’s contracture than women, and it is more likely to affect people in middle age and older.

White people of European ancestry have a higher chance of developing Dupuytren’s contracture, which is sometimes called the Viking disease. Prevalence in Norway has been estimated at 46 percent. In Asia, the figure is thought to be below 10 percent.

In the U.K., prevalence is estimated at between 3.5 percent and 30 percent. The wide range stems from differences in definition and diagnosis of the disease.

Alcohol addiction and tobacco were previously thought to be associated with the condition, but this has been disproven.

Patients with diabetes and those taking medication for epilepsy appear to be at higher risk.

Diagnosis

The physician will look for dimples, pitted marks, thickened skin, bent fingers, and lumps, or nodules.

The patient may be asked to do a “tabletop test,” patients place their hand flat on a table top, palm down. If they cannot flatten their hand, they probably have the condition.

Treatment

There is no permanent cure for Dupuyten’s contracture.

In many cases, no treatment is necessary, as long as the contracture is mild and does not progress at a rate that might stop a person from doing everyday chores.

Surgery may be carried out if there is a joint contracture that interferes with the use of the hand.

If tissue is wrapped around arteries and nerves, there is a risk of nerve or arterial injury. Surgery is normally carried out under local anesthesia or general anesthesia on an outpatient basis.


Surgery can help to regain hand function.

In a fasciotomy, connective tissue is cut to remove tension. With needle fasciotomy, the surgeon pushes a fine needle into the skin and over the contracture.

The needle has a sharp bevel, and it is used as a knife or saw. The slanted tip of the needle is used to cut the thickened tissue under the skin.

Fasciectomy is used in more severe cases, to remove connective tissue completely.

Physical therapy and occupational therapy may be needed after a surgical intervention to regain proper hand function.

Collagenase injections have been approved by the U.S. Food and Drug Administration (FDA). The enzyme collagenase, under the brand name Xiaflex, is injected into the cords, and it weakens them. In the next step, the cords can be pulled and broken, resulting in straight, functional fingers.

It is not yet clear how effective this treatment is in the long term, but the International Dupuytren’s Society mentions “good and longer term evidence of the therapy’s effectiveness.”

Steroid injections can be used in mild cases to soften and flatten the bumps of tissue.

Source: Dupuytren’s contracture: Symptoms, causes, and risk factors

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