Dupuytren’s contracture is a condition that causes thickening of the connective tissue (fascia) under the skin of your palm. As the disease progresses, bands of fascia in the palm develop into thick cords that can tether one or more fingers and the thumb into a bent position. The ring and little fingers are frequently affected. It tends to get slowly worse over many months or years.
What causes Dupuytren disease?
It is unclear what causes the disease. Family history plays a role, the disease being more common in men, people over 40 years of age and Northern European descent. Smoking, diabetes, alcohol and lower BMI are also related to Dupuytren contracture.
How do you know you have Dupuytren contracture?
Symptoms often include lumps, pits, nodules and cords that develop in the palm of your hands and may extend to the fingers. The cords are firm and stuck to the skin of the palm and may cause bending of the fingers. The disease is usually not painful. As disease progresses you may find it difficult to put the palm flat on a flat surface or have difficulties washing, wearing gloves or hold things.
It is difficult to predict how the disease progresses. Men, early debut, family history and contracture in other parts of the body are considered risk factors for a more aggressive form of the disease.
What is the treatment of Dupuytren’s contracture?
Not all lumps are Dupuytren disease. It is important to see a hand or Upper Limb surgeon for an examination. Some lumps require further tests such as x-rays, ultrasound or MRI.
Early stages do not usually require any treatment, however if the contracture prevents the palm from lying flat on the table treatment options can be discussed.
Non-surgical treatment consists in needle fasciotomy and collagenase injections. These can be done in clinic under local anaesthesia though sometimes are better done in theatre.
Surgical excision of the lumps and cords is called fasciectomy and is indicated when the deformity is more than 30 degrees or when the contracture affects the fingers. This can be done as a day surgery under a regional or general anaesthesia. It is worth mentioning that the main risk of all these procedures is recurrence of disease meaning that though cut or excised the cords may form again in time.