hand

Dupuytren’s contracture is a progressive hand deformity characterized by thickening and tightening of the connective tissue, or fascia, that lies just beneath the skin of the palm. This fibrous tissue eventually forms nodules, cords, and tight bands, causing the fingers, primarily the ring and little fingers, to bend into the palm. The bent fingers may be difficult or impossible to straighten, impacting the ability to grasp objects, perform daily routine activities, or even shake hands. Dupuytren’s contracture can significantly affect an individual’s hand function and quality of life and requires adept management and treatment approaches.

At North Florida Hand and Wrist, our team of highly-experienced hand and wrist surgeons, led by Dr. Richard D. Curtis and Dr. Jose Baez, is dedicated to providing top-tier care for patients suffering from Dupuytren’s contracture. Our state-of-the-art surgical facility, along with a team of committed practitioners, focuses on alleviating limitations associated with this potentially disabling condition and rehabilitating hand function.

In this in-depth guide, we will explore the causes, risk factors, and symptoms of Dupuytren’s contracture, examine the various diagnostic methods, and discuss the spectrum of non-surgical and surgical treatment options available at North Florida Hand and Wrist. Gaining a solid understanding of Dupuytren’s contracture and the most suitable treatment options enables patients to make well-informed decisions regarding their hand and wrist health, ensuring a comfortable and functional life.

Causes and Risk Factors of Dupuytren’s Contracture

The precise cause of Dupuytren’s contracture remains unknown; however, certain factors have been shown to increase the risk of developing this condition:

  1. Genetics: Dupuytren’s contracture tends to run in families and often affects individuals of Northern European or Scandinavian ancestry. A genetic predisposition appears to be a significant contributor to the development of this condition.
  2. Age and gender: Dupuytren’s contracture primarily affects older individuals, with most cases reported in people over the age of 40. Men are more likely to develop the condition than women and often experience more severe symptoms.
  3. Lifestyle factors: Tobacco and alcohol consumption have been linked to an increased risk of developing Dupuytren’s contracture.
  4. Medical conditions: Certain medical conditions, such as diabetes and epilepsy, have been associated with a higher risk of developing Dupuytren’s contracture.

Recognizing the Symptoms of Dupuytren’s Contracture

Symptoms of Dupuytren’s contracture can progress slowly over time, making it important to recognize the early signs:

  1. Thickening of palm skin: The initial presentation of Dupuytren’s contracture frequently involves the appearance of thickened or puckered skin on the palm, which can feel tender when touched.
  2. Nodule formation: As the condition progresses, firm nodules may emerge in the palm. These nodules are usually painless and may be mistaken for calluses.
  3. Cord development: Fibrous cords may form beneath the skin of the palm, extending to one or more fingers and exerting tension on these digits.
  4. Finger contracture: Over time, the fibrous cords can tighten and progressively pull the fingers towards the palm, leading to a bent posture that cannot be easily straightened.

Diagnosis of Dupuytren’s Contracture

A thorough physical examination and comprehensive review of medical history are key to accurately diagnosing Dupuytren’s contracture. During the examination, your healthcare provider will assess the palm and fingers, focusing on any thickened or tightened areas. They may also inquire about the onset, progression, and impact of symptoms on daily activities. In most cases, imaging tests like X-rays or MRI are not required, as diagnosis can be made through a physical examination.

Non-Surgical Treatment Options for Dupuytren’s Contracture

Conservative management strategies for Dupuytren’s contracture aim to alleviate discomfort and maintain hand function. While these interventions may not halt disease progression, they can minimize its effects:

  1. Monitoring: In early stages or mild cases, your healthcare provider may choose a wait-and-see approach, monitoring the progression of symptoms over time.
  2. Physical therapy: Hand exercises, massage, and heat application may be helpful for maintaining finger mobility, alleviating discomfort, and improving overall hand function.
  3. Splinting: Although the effectiveness of splinting in treating Dupuytren’s contracture remains controversial, it may be recommended in certain cases to help maintain finger extension and improve function.
  4. Injections: Corticosteroid injections may provide temporary relief of pain and inflammation in the early stages of Dupuytren’s contracture; however, they are not typically recommended as a long-term solution.
  5. Enzyme injections: A relatively new, non-surgical treatment involves injecting collagenase clostridium histolyticum (Xiaflex) into the cord(s) causing the finger contractures. The enzyme breaks down the cords and allows the finger to be straightened. This treatment may be appropriate for select patients with moderate contractures.

Surgical Treatment Options for Dupuytren’s Contracture

In more advanced cases of Dupuytren’s contracture, where conservative treatments are insufficient or the condition is severely limiting hand function, surgical intervention may be warranted. There are various surgical techniques to address Dupuytren’s contracture:

  1. Needle fasciotomy: This minimally invasive procedure involves using a needle to puncture and break the fibrous cords, thereby allowing the affected fingers to straighten. The recovery period is typically shorter than with more invasive surgeries.
  2. Open fasciotomy: A small incision is made in the palm to access and sever the fibrous cords. This procedure may be more suitable for cases with moderate contractures.
  3. Fasciectomy: In more severe cases or when finger contractures recur, a fasciectomy may be performed. This surgery involves removing the affected portions of the fascia through an incision in the palm and finger(s).

Conclusion

Dupuytren’s contracture can significantly impact hand function and limit daily activities. By seeking expert care at North Florida Hand and Wrist, patients can access various treatment options to alleviate pain and restore optimal hand function. Schedule an evaluation with our skilled professionals today to discover the best course of action for managing Dupuytren’s contracture.