Dupuytren’s contracture is a condition that causes one or more fingers to bend inward toward the palm of the hand due to the thickening and tightening of connective tissue (fascia) under the skin.

Common Symptoms

It starts with the formation of small, sore lumps (nodules) in the palm. Over time, these nodules thicken and form thick bands or cords under the skin. As the cords tighten, they pull one or more fingers, usually the ring and little fingers, into a bent position towards the palm, making it difficult to straighten the fingers. It can make everyday activities like placing hands in pockets, wearing gloves, or shaking hands difficult.

Cause & Anatomy

The exact cause is unknown, but it tends to run in families and is more common in men over 50 years old, those of Northern European descent and people with diabetes.

Dupuytren’s Contracture primarily affects the palmar fascia, which is the fibrous layer of tissue that lies underneath the skin and above the tendons, nerves, and bones in the palm and fingers.

Diagnosis

No advanced imaging tests or blood work are typically needed, as the diagnosis is primarily clinical based on the physical examination findings. Healthcare providers rely on the appearance of the hand, palpation of the abnormal tissue, and functional testing to diagnose Dupuytren’s contracture. An X-ray can look for other causes of stiffness including arthritis.

Prevention

There is no known way to definitively prevent Dupuytren’s contracture, as the exact cause is unknown. Unfortunately, even with preventative measures, Dupuytren’s contracture may still develop, especially if there is a family history or genetic predisposition. The condition often progresses slowly over years, and early preventative care focuses on slowing its advancement through lifestyle modifications and hand therapy exercises. Ultimately, there are no guaranteed preventative methods, but addressing potential risk factors may help reduce the likelihood of developing this condition.

Treatment

Nonsurgical treatments like injections are typically tried first for early-stage cases, while surgery is recommended when the contracture significantly impairs hand function. Physical therapy is often needed after surgery or injections to regain strength and range of motion.

Enzyme Injections (Xiaflex): An enzyme called collagenase is injected into the cords, which helps break them down. After the medication works for one – three days, the doctor numbs and stretches the finger to straighten the affected finger.

Surgery

The main surgical treatment for Dupuytren’s contracture is called fasciectomy. Here are the key details about this surgery: A fasciectomy involves making an incision in the palm of the hand and removing the thickened, contracted bands of tissue (fascia) that are pulling the fingers inward.

The goal is to release the tightened cords and allow the fingers to straighten and move more freely.

It is recommended for severe cases of Dupuytren’s contracture when the fingers have bent so far that hand function is significantly impaired.

Rehabilitation

Splinting and Immobilization:
After surgery, the hand is initially splinted or bandaged to protect the surgical area and maintain the corrected position of the fingers. Splinting helps prevent scar contracture and maintain the surgical release.

Edema Control:
Keeping the hand elevated above heart level helps reduce swelling in the initial postoperative period.

Scar Management:
Massaging and moisturizing the scar area once healed helps keep the scar soft and pliable.

Range of Motion Exercises:
Gentle active range of motion exercises for the fingers are often started 2-3 days after surgery to stimulate circulation. Tendon gliding exercises help restore smooth tendon motion. Exercises may include finger straightening, spreading, bending, making fists of different sizes.

Strengthening:
After regaining motion, gentle strengthening exercises are added, such as squeezing therapy putty. Grip and pinch strength need to be rebuilt over several months.

Follow-up Visits:
Patients are often seen weekly by a hand therapist to monitor progress and ensure recovery of motion. Therapy may be needed for up to 6 months to maximize results. Consistent adherence to the rehabilitation program is crucial for achieving optimal outcomes after Dupuytren’s release surgery.

FAQ’s

What if I suspect I have Dupuytren’s?
Seek an evaluation from a hand surgeon as soon as possible.

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