Hand & Wrist Orthopedic Care

Dupuytren’s contracture is a disease affecting the fascia of the digits and palms. The fascia is not a distinct anatomic layer but is instead a collection of specialized fibers which binds the individual tissue layers together. The fascia is similar to the glue which holds plywood layers together.

Dupuytren’s contracture develops from normal fascia and the cause is unknown. There is probably a genetic basis for the disease. For example, there is a strong association in men whose ethnic background is from Northern European countries.

Dupuytren’s contracture at a glance:

• Dupuytren’s contracture is a disease that causes hard lumps to appear in the palm of the hand.
• As Dupuytren’s contracture progresses, it causes the fingers to bend downward.
• Surgery is the most effective treatment for Dupuytren’s contracture.

Prevention of Dupuytren’s Contracture

Molecular investigation has identified specialized cells that may control the growth of Dupuytren’s contracture. An active metabolic process at the cellular level may cause normal fascia to become diseased. Surgical removal of the fascia does not disrupt or prevent the cellular activity and the disease can progress. Future investigation involves finding medication which blocks the activity of the cells. Presently, there is no method to prevent Dupuytren’s contracture.

Symptoms of Dupuytren’s Contracture

The first sign is the presence of small nodules in the palm of the hand, which feel like hard lumps. Over several months or years, the nodules can coalesce and grow together to form long bands called cords. As the cords become further diseased, they can bend the fingers down, resulting in the inability to fully straighten the finger, which is called contracture. The cords will typically affect the ring and small fingers, and in some individuals can affect all of the digits. Dupuytren’s nodules and cords are usually not painful, but the loss of motion can interfere with activities.

Dupuytren’s contracture represents a benign disease and usually does not spread to other areas. Certain patients can develop cords and nodules on the soles of their feet and Dupuytren’s contracture can rarely be associated with other illnesses, such as diabetes and alcoholism.

Treatment of Dupuytren’s Contracture

Surgery is the most effective treatment. Surgery is postponed until the finger loses approximately 20-30 degrees of motion and the patients can no longer place their hands flat on a tabletop.

Surgery for Dupuytren’s contracture proceeds as follows:

• The skin overlying the diseased cord is incised in a zig-zag fashion.
• The tendons, nerves, and blood vessels are identified and protected, and the diseased fascia is surgically removed.
• Any surrounding fascia which is obviously diseased is also removed.

Surgery to remove normal fascia has not been helpful and does not seem to affect the progression of further contractures. Therefore, the surgery is limited to removing the diseased tissue. Surgery can be very meticulous in order to protect the delicate neurovascular structures while removing all of the diseased fascia.

Outcome

The outcome following surgery is highly dependent on individual circumstances. Surgery can be extensive and requires several weeks to a few months of postoperative recovery. Patients will typically require hand therapy. This includes the use of specialized splints and supervised therapy in order to regain motion and strength. Most patients are able to resume normal daily activities within a few weeks. Vigorous activities such as sports may require several months of recovery.

There can be a recurrence of Dupuytren’s contracture in about 30 percent of patients within five years of surgery. The reason for this recurrence is not clearly known. It usually does not recur to the same extent that initially required surgery and additional treatment is usually not necessary. In the event that the disease progresses to require additional surgery, then not only is the diseased fascia removed but sometimes the overlying skin is surgically removed and replaced with a skin graft.