Dupuytren contracture is a progressive tightening of the bands of fibrous tissue (called fascia) inside the palms, causing a curling in of the fingers that eventually can result in a clawlike hand.
Dupuytren contracture develops in people who are genetically predisposed.
Typical symptoms include formation of a nodule in the palm and, eventually, curling in of the fingers.
Doctors base the diagnosis on an examination of the hand.
(See also Overview of Hand Disorders.)
Dupuytren contracture is a common hereditary disorder that occurs particularly in men, especially after age 45. However, having the abnormal gene does not guarantee that someone will have the disorder. About 5% of people in the United States have Dupuytren contracture. The disorder affects both hands in 50% of people. When only one hand is affected, the right hand is affected twice as often as the left.
Dupuytren contracture is more common among people with diabetes, alcoholism, or epilepsy. The disorder is occasionally associated with other disorders, including thickening of fibrous tissue above the knuckles (Garrod pads), shrinking of fascia inside the penis that leads to deviated and painful erections (penile fibromatosis [Peyronie disease]), and, rarely, nodules on the soles of the feet (plantar fibromatosis). However, the specific factors that cause the fascia of the palm to thicken and curl in are unknown.
Symptoms of Dupuytren Contracture
DR P. MARAZZI/SCIENCE PHOTO LIBRARY
The first symptom of Dupuytren contracture is usually a tender nodule in the palm (most often at the ring or small finger). The nodule may initially cause discomfort but gradually becomes painless. Gradually, the fingers begin to curl. Eventually, the curling worsens, and the hand can become arched (clawlike).
Diagnosis of Dupuytren Contracture
A doctor's examination
The doctor makes the diagnosis of Dupuytren contracture by examining the hand.
Treatment of Dupuytren Contracture
Injection of a corticosteroid
Surgery
In people with Dupuytren contracture, an injection of a corticosteroid into the nodule may help decrease the tenderness in the area if it is done before the fingers begin to curl. However, the tenderness often resolves without treatment. The injection does not delay the progression of the disorder.
Surgery is usually needed when the hand cannot be placed flat on a table, when the fingers curl so much that hand function is limited, or when multiple fingers are involved. Surgery to remove the diseased fascia is difficult because the fascia surrounds nerves, blood vessels, and tendons
