Dupuytren contracture is a painless thickening and tightening (contracture) of tissue beneath the skin on the palm of the hand and fingers.One or both hands may be affected. The ring finger is affected most often, followed by the little, middle, and index fingers.
Risk Factors
The condition is more common after age 40. Men are affected more often than women. Risk factors are alcohol use, diabetes, and smoking.
Causes
The cause is unknown. You are more likely to develop this condition if you have a family history of it. It does not seem to be caused by occupation or from trauma.
Symptoms
A small, nodule or lump develops in the tissue below the skin on the palm side of the hand. Over time, it thickens into a cord-like band. Usually, there is no pain. In rare cases, the tendons or joints become inflamed and painful. Other possible symptoms are itching, pressure, burning, or tension.
As time passes, it becomes difficult to extend or straighten the fingers. In severe cases, straightening them is impossible.
Diagnosis
The health care provider will examine your hands. Diagnosis can usually be made from the typical signs of the condition. Other tests are rarely needed.
Treatment
If the condition is not severe, your provider may recommend exercises, warm water baths, stretching, or splints.
Your provider may recommend treatment that involves injecting medicine or a substance into the scarred or fibrous tissue:
Corticosteroid medicine relieves inflammation and pain. It also works by not allowing thickening of the tissue to get worse. In some cases, it heals the tissue completely. Several treatments are usually needed.
Collagenase is a substance known as an enzyme. It is injected into the thickened tissue to break it down. This treatment may be just as effective as surgery.
Surgery may be done to remove the affected tissue. Surgery is usually recommended in severe cases when the finger can no longer be extended. Physical therapy exercises after surgery help the hand recover normal movement.
A procedure is called aponeurotomy may be recommended. This involves inserting a small needle into the affected area to divide and cut the thickened bands of tissue. There is usually little pain afterward. Healing is faster than surgery.
Radiation is another treatment option. It is used for mild cases of contracture, when the tissue is not so thick. Radiation therapy may stop or slow down thickening of the tissue. It is usually done only one time.
Recovery
The disorder progresses at an unpredictable rate. Surgery can usually restore normal movement to the fingers. The disease can recur within 10 years after surgery in up to half of cases.
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