Dupuytren's contracture is a thickening of the tissue below the skin in the palm of the hand. As a result of this thickening, lumps can form beneath the skin, usually appearing at the base of the ring and pinkie fingers. These lumps eventually develop into a thick band, called a cord, which extends into the fingers, causing them to contract or pull into the palm. Dupuytren’s contracture can also affect the knuckles of the fingers by creating lumps or bands over the knuckle pads. In most cases Dupuytren’s contracture affects both hands, though one hand tends to be affected to a greater degree than the other. It is rare for both the thumb and index finger to be affected. This hand deformity develops slowly over time, though there are instances of it developing in as little as a few weeks.
The cause of Dupuytren’s contracture is unknown. There appear to be certain risk factors, but there are no proven links between the disease and certain hand exposures or injuries. Risk factors for Dupuytren’s contracture are:
- Men over 40 years old of Northern European descent are at the highest risk of contracting Dupuytren’s disease. When women contract this disease, they are usually older and their symptoms tend to be milder.
- Seizure disorders and diabetes have been linked to Dupuytren’s contracture, yet the reason for the association is unexplained.
- Heredity and ancestry are the greatest risk factors, though not necessarily deciding factors in contracting Dupuytren’s contracture.
Discomfort in the hands is not a common symptom of Dupuytren’s contracture. You may experience one or more of the following symptoms of Dupuytren's contracture:
- Lumps or pits – These form in the palm, usually at the base of your ring and pinkie fingers. The lumps are usually firm and will adhere to the skin.
- Dimpled skin – As Dupuytren’s contracture develops, the skin on the palm of your hand may appear dimpled or puckered.
- Thick cords – These cords usually develop in the palm and extend into the affected finger(s). The cords can be mistaken as tendons, but they lie between the tendons and the skin.
- Bending or contracture – This is a result of the thick cords running between the palm and the fingers. As the cord develops, the affected fingers are pulled down toward the palm, preventing them from straightening properly.
- Increased difficulty using hands – Placing your hand flat on a surface, wearing gloves, putting your hand in your pocket and shaking hands can become very difficult in the later stages of the disease.
- Inability to straighten the fingers – People with Dupuytren’s contracture eventually will be unable to straighten the fingers affected by the condition.
Treatments for Dupuytren's contracture depend upon the severity of the condition. There are three treatments that are most commonly used to treat Dupuytren’s disease:
- One nonsurgical treatment is enzyme injections. The treatment uses an injection of an enzyme that digests the cord over night to weaken the cord so that it can be broken by your doctor the next day.
- The second treatment is an office procedure called percutaneous fasciotomy, which is cutting the cord with the tip of a needle placed through the skin.
- The third treatment is Dupuytren's contracture release surgery, the most commonly used treatment that removes the cord and the nodules, or lumps, in the palm, and is done as an outpatient operation.
The multidisciplinary team of hand and wrist experts at Northwell Health Orthopaedic Institute treats Dupuytren's contracture as well as a broad range of hand and wrist conditions that can occur at any stage of life.