Dupuytren Contracture

What is Dupuytren contracture?

Dupuytren contracture (also called Dupuytren disease) is an abnormal thickening of the skin in the palm of your hand at the base of your fingers. This thickened area may develop into a hard lump or thick band. Over time, it can cause one or more fingers to curl (contract), or pull sideways or in toward your palm.

The ring and little fingers are most commonly affected. In many cases, it affects both hands. Rarely, feet may also be affected.

What causes Dupuytren contracture?

Dupuytren contracture is believed to run in families (be hereditary). The exact cause is not known.

It may be linked to cigarette smoking, alcoholism, diabetes, nutritional deficiencies, or medicines used to treat seizures.

Who is at risk for Dupuytren contracture?

You may be at greater risk for Dupuytren contracture if you:

• Are older. The condition usually starts in middle age.

• Are male. It is more common in men than women.

• Have a Scandinavian or Northern European background. It is most common in people whose families come from these regions.

• Have a family history. The condition is often found in families, so it may be inherited.

• Take seizure medicine. It is linked with some medicines used to treat epileptic seizures.

• Smoke or abuse alcohol.

• Have diabetes.

What are the symptoms of Dupuytren contracture?

Common symptoms may include:

• Not being able to lay your hand flat on a table, palm down (called the tabletop test)

• One or more small, sore lumps (nodules) in the palm. Over time, the soreness usually goes away.

• The nodules may thicken and contract or tighten. This can cause thick bands of tissue under the skin in the palm of the hand.

• Pits or grooves in the skin compressed by the contracted finger. These areas can become very sore and can lead to skin loss if they don’t heal well.

• Fingers are pulled forward

• Your hand is not able to work as well

The symptoms of Dupuytren contracture may look like other health problems. Always see your healthcare provider for a diagnosis.

How is Dupuytren contracture diagnosed?

Your healthcare provider will examine your hand. They will test the flexibility and feeling in your thumb and fingers. Your grip and pinch strength may also be tested.

Your healthcare provider will measure and record the locations of nodules and bands on your palm. Using a special tool, they will measure how much your fingers are curling or contracting. Range of motion in your fingers may also be measured.

These measurements will be compared to later measurements to see if the disease gets any worse. They can also be used to see if treatment is working.

How is Dupuytren contracture treated?

Your healthcare provider will create a care plan for you based on:

• Your age, overall health, and past health

• How serious your case is

• How well you handle certain medicines, treatments, or therapies

• If your condition is expected to get worse

• What you would like to do

There is no cure for Dupuytren contracture. The condition is not dangerous. Many people don’t get treatment. But treatment can slow the disease or help ease your symptoms.

Treatments for Dupuytren contracture may include:

• Surgery. This is the most common treatment used for advanced cases. It may be done when you have limited use of your hand. During surgery, the surgeon makes a cut (incision) in your hand and takes out the thickened tissue. This can improve the mobility of your fingers. Some people have contractures return. They may need surgery again.

• Steroid shot (injection). If a lump is painful, a steroid injection may help ease the pain. In some cases, it may stop your condition from getting worse. You may need repeated injections.

• Radiation therapy. This treatment is not as common in the U.S. Low energy X-rays are directed at the nodules. This works best in the early stage of the disease. It can soften the nodules and help keep contractures from happening.

• Enzyme injection. This is a newer, less invasive procedure done by specially trained surgeons. At the first visit your healthcare provider injects an enzyme medicine into the lump of tissue. Over several hours, the enzyme breaks down and dissolves the tough bands. At a second visit, usually 1 to 2 days later, the healthcare provider will inject the hand with numbing medicine. Then they will slowly stretch and straighten the finger joints until the cord is broken.

• Needle aponeurotomy. This is another newer, less invasive procedure, often used in more mild contractures. Medicine is injected into the area to numb the hand. The surgeon uses a needle to divide the diseased tissue. No incision is made.

What are possible complications of Dupuytren contracture?

Over time, you may have trouble using your hand for certain tasks. You may not be able to grasp large objects or straighten your fingers.

When should I call my healthcare provider?

Call your healthcare provider if your symptoms get worse or you have new symptoms.

Key points about Dupuytren contracture

• Dupuytren contracture is an abnormal thickening of the skin in the palm of the hand.

• The skin may develop into a hard lump. Over time, it can cause one or more fingers to curl (contract) or pull in toward the palm.

• You may not be able to use your hand for certain things.

• In many cases, both hands are affected.

• There is no cure, but treatment can improve symptoms.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours and on weekends and holidays.