Overview
Dupuytren contracture is a painless condition that causes one or more fingers to bend toward the palm of the hand. The affected fingers can't straighten completely. Over time, knots of tissue form under the skin, creating a thick cord that pulls the fingers into a bent position. The condition gradually worsens over time and usually affects the two fingers farthest from the thumb. There's no cure for Dupuytren contracture, but treatments can relieve symptoms and slow its progression. The exact cause of the condition is unknown, but it tends to run in families and is more common in people of Northern European descent, men, and those with certain risk factors such as age, diabetes, tobacco, and alcohol use.
Understanding the disease
Symptoms
The symptoms of Dupuytren contracture include the formation of firm lumps in the palm of the hand, which may extend into a hard cord under the skin that tightens and pulls the affected finger(s) towards the palm. The condition typically affects the two fingers farthest from the thumb and can make everyday activities like placing hands in pockets or shaking hands difficult. The symptoms progress slowly over years and are not usually painful.
Risk Factors
The risk factors for developing Dupuytren contracture include:
- Age: Dupuytren contracture typically occurs after the age of 50.
- Sex: Men are more likely to develop Dupuytren contracture than women. In men, the condition may be more severe and progress faster.
- Ancestry: People of Northern European descent are at a higher risk of developing Dupuytren contracture.
- Family history: The condition often runs in families, indicating a genetic predisposition.
- Diabetes: People with diabetes have an increased risk of developing Dupuytren contracture.
- Certain medical conditions: Conditions like Guillain-Barre syndrome, carpal tunnel syndrome, autoimmune diseases such as lupus, rheumatoid arthritis, and Sjogren's syndrome, as well as narrowing of the arteries, hormonal imbalances, and tumors can also increase the risk.
Development
Dupuytren contracture develops as knots of tissue form under the skin, eventually creating a thick cord that pulls the affected fingers into a bent position. It generally starts as a firm lump in the palm of the hand, which might be a little tender but is usually not painful. Over time, the lump can extend into a hard cord under the skin and up into the finger, tightening and pulling the finger toward the palm. Dupuytren contracture most commonly affects the two fingers farthest from the thumb and can complicate everyday activities such as placing hands in pockets, putting on gloves, or shaking hands. The condition is long-term (chronic) and tends to worsen slowly over years.
Assessment and Diagnosis
Triage
If you notice any of the following symptoms, you should consider seeing a doctor for a possible Dupuytren contracture evaluation:
- Lumps or knots have appeared for no apparent reason and have been present for two to four weeks or more.
- The lumps or knots continue to enlarge over time.
- The lumps or knots feel hard or rubbery, or do not move when you push on them.
- If you experience any unusual symptoms such as persistent fever, unexplained night sweats, or significant weight loss, as these could potentially indicate an underlying infection or other health issue. Remember that Dupuytren contracture is a progressive condition, so it's important to monitor any changes in your condition and seek medical advice if needed.
Diagnosis
The diagnosis of Dupuytren contracture is primarily based on the physical examination of the hands. Healthcare providers compare the hands with each other and check for puckering on the skin of the palms, as well as pressing on parts of the hands and fingers to check for hard knots or bands of tissue. Another test for Dupuytren contracture involves placing the palm of the hand flat on a tabletop or other flat surface. If the fingers cannot be fully flattened, treatment might be necessary. However, if the disease progresses slowly, causes no pain, and has little impact on daily activities, observation may be appropriate. If the case is severe, surgical intervention might be necessary.
Management and Treatment
Complications
Potential complications of Dupuytren contracture include:
- Loss of hand function: The progressive tightening of cords can cause the affected fingers to bend inward, making it difficult to perform daily tasks or even to straighten the affected fingers.
- Infection: In some cases, the cords may rupture, leading to infection in the affected area. Prompt medical attention is necessary in such cases.
- Nerve damage: Dupuytren contracture can cause compression of nerves, which may result in numbness, tingling, or weakness in the affected hand or fingers.
- Limited range of motion: Over time, the progressive thickening and tightening of tissues can lead to limited finger and wrist movement, affecting overall hand function.
- Cosmetic concerns: The visible lumps, cords, and changes in skin texture associated with Dupuytren contracture may cause discomfort or self-consciousness for some individuals.
- Complications in rare cases: In some instances, Dupuytren contracture can involve other parts of the body, leading to thickening and tightening of skin and tissue in areas such as the arms, legs, or other parts of the body. This can result in severe disability or even organ dysfunction in extreme cases. However, such cases are rare. It is important to seek medical advice if you suspect you have Dupuytren contracture or are experiencing any of these complications.
Treatment
Treatments for Dupuytren Contracture There is no cure for Dupuytren contracture, but treatments can help relieve symptoms and slow the progression of the condition. Some of the treatment options include:
- Needle aponeurotomy (NA): A minimally invasive procedure that uses a needle to puncture the cord and break down the fibrous tissue. This can help improve finger movement and reduce curvature.
- Surgery: Surgical options include fasciectomy, where the affected tissue is removed, and dermofasciectomy, which involves removing the skin and affected tissue. Surgery can be effective in improving finger function, but it may also have risks and complications, such as nerve damage, bleeding, or infection.
- Enzyme injections: Collagenase injections can help dissolve the fibrous tissue and improve finger mobility. These injections may be an option for those who wish to avoid surgery or have mild to moderate cases of Dupuytren contracture.
- Physical therapy: In some cases, physical therapy may help improve finger mobility and reduce stiffness. A physical therapist can teach exercises and stretches to help maintain or improve finger function.
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections may help reduce pain and inflammation associated with Dupuytren contracture. It is important to discuss treatment options with a healthcare professional to determine the most appropriate course of action based on your specific case and severity of the condition.