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.
Treatment may involve injection of a corticosteroid into a tender nodule or, if the hand is already scarred, injection of collagenase into a nodule or surgery to correct contracted (clawed) fingers.
(See also Overview of Hand Disorders Overview of Hand Disorders Hand and finger disorders include ganglia, deformities, disorders related to nerves or blood vessels, osteoarthritis, trigger finger, Kienböck disease, and infections. Some other disorders that... read more .)
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 Peyronie Disease Peyronie disease is a fibrous thickening that contracts and deforms the penis, distorting the shape of an erection. Many men have a small degree of curvature of their erect penis. Peyronie disease... read more ]), 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
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
Injection of collagenase
In people with Dupuytren contracture, an injection of a corticosteroid Corticosteroids Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more 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.
For mild to moderate scarring, one or more injections of collagenase (an enzyme that can break down scar tissue) may help restore the ability to move. Another alternative to surgery is needle aponeurotomy, an office-based procedure in which a needle is used to release the tightened band of scar tissue to straighten the finger.
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 Tendons and Bursae Tendons are tough bands of connective tissue made up mostly of a rigid protein called collagen. Tendons firmly attach each end of a muscle to a bone. They are often located within sheaths, which... read more , although recurrence is less likely after surgery than after collagenase injections or needle aponeurotomy. Also, Dupuytren contracture may return after surgery if removal of the fascia is incomplete or newly diseased fascia have developed, especially in people who developed the disorder at a young age or have family members affected by the disorder or in people who have Garrod pads, Peyronie disease, or nodules on the soles of the feet.