Introduction
Dupuytren’s contracture is a progressive hand condition characterized by thickening and tightening of the connective tissue (fascia) beneath the skin of the palm and fingers. Over time, this can cause one or more fingers—most commonly the ring and little fingers—to bend toward the palm, making it difficult to fully straighten the hand. Early recognition and appropriate management are important for maintaining hand function and quality of life.
Causes
The exact cause of Dupuytren’s contracture is not fully understood, but several factors are known to increase risk:
- Genetic Predisposition: The condition often runs in families and is more common in individuals of Northern European descent.
- Age: It typically develops after the age of 40.
- Gender: Men are more frequently affected than women.
- Lifestyle Factors: Smoking and excessive alcohol consumption may increase risk.
- Medical Conditions: Diabetes and certain seizure disorders are associated with a higher incidence.
- Hand Trauma: Previous injury to the hand may contribute, though this is less common.
Symptoms
Symptoms of Dupuytren’s contracture usually develop gradually and may include:
- Nodules: Small, firm lumps in the palm, often near the base of the fingers.
- Cords: Thickened bands of tissue that can be felt under the skin.
- Finger Contracture: One or more fingers, especially the ring and little fingers, begin to bend toward the palm and cannot be fully straightened.
- Loss of Hand Function: Difficulty performing tasks that require the hand to be flat or the fingers to be fully extended.
- Painless Progression: The condition is usually not painful, though some may experience mild discomfort.
Diagnosis
Diagnosis is based on clinical evaluation:
- Medical History: Review of symptoms, family history, and risk factors.
- Physical Examination: Assessment of the hand for nodules, cords, and degree of finger contracture. The table top test (inability to lay the hand flat on a surface) is often used.
- Imaging: Rarely needed, but ultrasound or MRI may be used in atypical cases.
Treatment Options
Treatment depends on the severity of the contracture and its impact on hand function:
- Observation: In mild cases with minimal contracture, regular monitoring may be sufficient.
- Needle Aponeurotomy: A minimally invasive procedure where a needle is used to break the thickened cords, allowing the finger to straighten.
- Enzyme Injections: Collagenase injections can dissolve the cords, followed by manipulation to improve finger extension.
- Surgery: In more advanced cases, surgical removal of the affected tissue (fasciectomy) may be necessary to restore hand function.
- Physical Therapy: Post-procedure or post-surgical therapy helps maintain range of motion and prevent recurrence.
- Splinting: May be used after treatment to support finger extension.
Prevention
There are no proven methods to prevent Dupuytren’s contracture, but managing risk factors may help:
- Avoid Smoking and Excessive Alcohol: Reducing these lifestyle risks may lower the chance of developing the condition.
- Manage Chronic Conditions: Good control of diabetes and other associated health issues.
- Early Intervention: Seek medical advice if you notice lumps or thickening in the palm.
Takeaway
Dupuytren’s contracture is a chronic hand condition that can limit finger movement and hand function. While the progression is often slow, early diagnosis and appropriate treatment can help maintain hand mobility and improve quality of life. If you notice changes in your hand or difficulty straightening your fingers, consult a healthcare provider for evaluation and guidance.