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Dupuytrens Contracture

Pronounced: du-pwe-trahn kon-trak-choor

Definition

Dupuytrens contracture is a thickening of tissue just under the skin in the palm of the hand. The thickening causes the tissue to shorten and curl affected fingers toward the palm. It can make extension of these fingers difficult or impossible. The most common affected fingers are the pinky and the ring finger.

Dupuytrens Contracture Scarring

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Causes    TOP

The exact cause of Dupuytrens contracture is unknown. For some people, the condition is inherited.

Risk Factors    TOP

This condition is more common in men and those over 40 years of age.

Factors that may increase your chances of getting Dupuytrens contracture include:

  • A parent with Dupuytrens contracture
  • Hand trauma
  • Manual labor
  • Vibration exposure at work
  • Alcohol use disorder
  • Epilepsy
  • Use of certain anticonvulsant medications for epilepsy
  • Liver disease
  • Smoking
  • Diabetes

Symptoms    TOP

At first, the curling of the fingers are mild. It may worsen over time. How fast it worsens can differ from person to person.

The ring finger is usually affected first, followed by the pinky finger. The index, and long finger may follow. Fingers on either or both hands can be affected. The first physical sign of this condition is a bump in the palm near the bottom of a finger. In some cases, the bump can be sensitive to touch. Generally, though, this condition is not painful.

Eventually, the bump may becomes a thickened fibrous cord. As the cord thickens, it shortens and curls the affected finger toward the palm. Movement in the finger will become more difficult.

Diagnosis    TOP

You will be asked about your symptoms and medical history. A hand examination will be done.

Images may be taken of your hand. This can be done with:

Treatment    TOP

Treatment is made easier and more effective when the contracture is detected early. Treatment may not be needed at first if you can still use your hand normally. When needed, treatment options include:

Surgery

Surgery is most effective when the condition is still in the early stage.

Depending on how far the condition has progressed, surgery may involve:

  • Making small incisions in the thickened tissue
  • Removing diseased tissue
  • Removing diseased tissue and overlying damaged skin. Gap in skin may then be repaired with skin grafts
  • Percutaneous needle fasciotomy—can release tissue without large incisions

Dupuytrens contracture can begin again after surgery.

Exercise Therapy After Surgery

Therapy may be needed to help restore full range of motion to the fingers after a repair.

Injected Medication    TOP

Injecting corticosteroids into bumps during early stages of the condition can sometimes:

  • Slow the worsening of the condition
  • Ease any tenderness that may be present in the nodules

Collagenase clostridium histolyticum may also be injected. This medication breaks down the thickened tissue in the hand.

Prevention    TOP

There is nothing that has been shown to prevent Dupuytrens contracture. Its cause is unknown.

RESOURCES:

American Society for Surgery of the Hand
http://www.assh.org
Family Doctor—American Academy of Family Physicians
http://familydoctor.org

CANADIAN RESOURCES:

Canadian Centre for Occupational Health and Safety
http://www.ccohs.ca

References:

Badalamente MA, Hurst LC, Benhaim P, Cohen BM. Efficacy and safety of collagenase Clostridium Histolyticum in the treatment of proximal interphalangeal joints in Dupuytren contracture: Combined analysis of 4 phase 3 clinical trials. J Hand Surg. 2015;5:975-983.
Degreef I, Tejpar S, Sciot R, De Smet L. High-dosage Tamoxifen as neo adjuvant treatment in minimally invasive surgery for Dupuytren Disease in patients with strong pre disposition toward fibrosis. J Bone Joint Surg Am. 2014;96(8):655-662.
Dupuytren disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114104/Dupuytren-disease. Updated February 8, 2017. Accessed September 7, 2017.
Lanting R, Broekstra DC, Werker PMN, van den Heuvel ER. A systematic review and meta-analysis on the prevalence of Dupuytren Disease in the general population of Western countries. Plast Reconstr Surg. 2014;133(3):593-603.
Rahr L, et al. Percutaneous needle fasciotomy for primary Dupuytren's contracture. J Hand Surg Eur Vol. 2011;36(7):548-552.
Riester S, vanWijnen A, Rizzo M, Kakar S. Pathogenesis and treatment of Dupuytren disease. J Bone Joint Surg Reviews. 2014;2(4):e2.
van Rijssen AL, et al. Five-year results of a randomized clinical trial on treatment in Dupuytren's disease: percutaneous needle fasciotomy versus limited fasciectomy. Plast Reconstr Surg. 2012 Feb;129(2):469-77.
2/12/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114104/Dupuytren-disease: FDA approves Xiaflex for debilitating hand condition. US Food and Drug Administration website. Available at:
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Published February 2, 2010. Accessed September 23, 2014.
Last reviewed January 2018 by EBSCO Medical Review BoardTeresa Briedwell, PT, DPT, OCS, CSCS
Last Updated: 2/7/2018

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