Dupuytrens Contracture

Dupuytren’s contracture is a hand deformity that usually develops over years. The condition affects a layer of tissue that lies under the skin of the palm, eventually creating a thick cord that can pull one or more fingers into a bent position.

The affected fingers can’t be straightened completely, which can complicate everyday activities such as placing your hands in your pockets, putting on gloves or shaking hands.

Dupuytren’s contracture mainly affects the ring finger and pinky, and occurs most often in older men of Northern European descent. A number of treatments are available to slow the progression of Dupuytren’s contracture and relieve symptoms.

Dupuyten’s contracture affects the fascia of the hand, which is the thin but sturdy layer of tissue that overlays the tendons and bones, just underneath the skin. Dupuytren’s causes the fascia to thicken, often in the form of nodules, which is generally the first sign of the condition. You may notice this thickening, but it is not painful, so it is often overlooked at first.

As the fascia thickens, however, it can limit your ability to extend your fingers, and that is when the problems begin. This thickened fascia is often visible in the form of cords that become prominent on the palm side of the hand, which are is the visible thickening and shortening of the fascia. The cord usually extends from the mid-palm to the first or second knuckle of the affected finger, but usually not as far as the DIP joint. The ultimate result of this is that the affected fingers curl into the palm and it become impossible to straighten them.

Initial non-surgical options for the treatment of Dupuytren’s Contracture include enzyme injections and percutaneous needle release. Enzyme injections consist of the introduction of an enzyme into the fascia that actually dissolves the built-up tissue, and in some cases can prove effective.

Most commonly, surgery is the only effective way to treat Dupuytren’s contracture. Surgery is indicated after the finger reaches a 30 degree bend from straight at the knuckle, or especially any flexion in the PIP joint.

Post-operative wound check will take place about three days after surgery, at which time your splint will be removed, and you will be fitted with a removable brace. You will also being therapeutic exercises at this time, consisting of bending the fingers, because if you fail to do so, flexion may be adversely affected even after this surgery. The splint’s purpose is to hold the fingers in extension while you are not exercising, or otherwise engaged in activity. After ten days, your stitches are removed and you may begin to resume normal activities.

Total recovery period is about two to three months for full recovery, and there is about a 25% recurrence rate, because this disease is genetic in nature, and so not easily curable. More than one finger may be affected at a time, or they may be affected in succession over a period of years.