Overview and Facts about Dupuytren's Contracture
Dupuytren’s contracture occurs when abnormally thick tissue forms under the skin in the palm and fingers. These formations make pits, thick lines and bumps across the palm and can lead to the development of thick cords that cause the fingers to curl. Rarely, Dupuytren’s contracture can cause thickening on the knuckles or the soles of the feet. Once this hand deformity progresses, it affects daily functioning and can make things like putting on gloves or shaking hands extremely difficult.
Signs and Symptoms of Dupuytren's Contracture
The most common symptoms of Dupuytren’s contracture are the telltale lumps and pits that form on the palm, causing the skin to look puckered. The lumps are firm and attached to the skin, not the underlying structures. Although these disfigurements can form on any of the fingers, they are most common on the ring finger and pinky. The condition can affect one or more fingers on either hand, but it most often develops on both hands.
Because orthopaedic conditions like Dupuytren’s contracture typically do not cause pain, the first noticeable sign of the disease is realizing that it is hard to place the hand flat on a table.
Causes and Risk Factors of Dupuytren's Contracture
The underlying cause of Dupuytren’s contracture is unknown, but it occurs more frequently in men and people over 50. Additional identified risk factors include:
- Having northern European ancestry
- Using tobacco and alcohol
- Having a family history of the disease
- Suffering from diabetes
Tests and Diagnosis of Dupuytren's Contracture
In most cases, a doctor can diagnose Dupuytren’s contracture through a physical examination of the hand. They may feel for thickening of the palm’s tissues as well as puckering, pits, and lumps. The doctor might feel the fingers, pressing into the tissue to look for knots or cords. They may compare one hand to the other to check for differences and ask you to place your hand flat on a table.
Treatment and Care for Dupuytren's Contracture
In many cases, a doctor opts for observation of the hand to monitor the progression of the disease. Dupuytren’s contracture doesn’t always progress into deformity, and the presence of a lump in the palm doesn’t mean cords will develop and cause the fingers to curl.
If the condition causes issues with how the hand and fingers function, the doctor might recommend needling. During this procedure, the doctor punctures the cord that’s impacting your finger with a needle, breaking up the tissue.
If needling isn’t possible, the doctor might suggest enzyme injections given directly into the tissue formation, causing it to soften and weaken. Once the cord becomes flexible, the doctor manipulates the hand and finger to try to break the cord.
In severe cases, the doctor might recommend surgery to remove the tissue formations in the palm and fingers. Surgery is generally more effective than the less invasive methods, but it often requires splinting the fingers and engaging in hand therapy to restore finger movement and range of motion.