Dupuytren’s contracture: Causes & Symptoms

We can help you straighten out your fingers

Dupuytren’s contracture (also known as palmar fibromatosis) is a common benign condition that forms hard nodules in the palmar fascia just beneath the skin of the palm of the hand, commonly affecting the ring or little finger. They can extend to form cords that cause your fingers to pull into a bent position.
This is a familial condition and whilst you may not be cured of the tendency to form contracture, the nodules and bands of tissue can be excised or released to allow restoration of function.

At Schoen Clinic London we specialise in the treatment of hand diseases. Your specialist will discuss together with you the alternatives to relieve your symptoms and what can you expect after your treatment.

What is dupuytren’s disease?

Dupuytren’s disease is a familial condition in most cases, usually inherited from one of your parents. It is most common in Scandinavia and it is often said that it was the Vikings who spread the gene. It is often not a serious condition but can be quite debilitating when the contractures are severe.

Dupuytren's disease not only occurs in the palm of the hand, but it can also affect other parts of the body such as the back of the finger knuckles (Garrod's pads or knuckle pads) and on the sole of the foot (Ledderhose disease).

Dupuytren’s disease is more common in middle-aged men of Viking descent and often runs in families.

Symptoms of Dupuytren’s contracture

Dupuytren's contracture often begins with swellings in the palm, stiffness, and an inability to straighten the fingers.
The nodules are sometimes uncomfortable on pressure in the early stages. In about one in three people, the nodules form cords that pull the finger towards the palm and prevent it straightening fully. Without treatment, one or more fingers may become involved. Finger contracture is slow and usually occurs over months and years.

What are the causes of Dupuytren’s contracture?

Although the cause is still unknown, Dupuytren's contracture may be associated with the following:

Diabetes
Smoking
High alcohol consumption
It does not appear to be associated with manual work
It can appear after an injury to the hand or after surgery to these areas

Diagnostics

Dupuytren’s contracture is a clinical diagnosis and does not usually require any specific investigation to confirm. In rare circumstances with unusual symptoms, imaging in the form of ultrasound may help in differentiating diagnoses.

We offer different treatment options for the contracture of your hand

Surgery is not needed if the finger can be straightened fully. Intervention is generally recommended when the patient develops contractures of the finger joints of greater than 30 degrees and when it has become impossible to put the hand flat on the table.

Over the longer term, Dupuytren's contracture may reappear in the operated fingers or in previously uninvolved areas of the hand, although most patients who require surgery need only one operation during their lifetime. There are two types of surgery for Dupuytren’s contractures and the choice between these two depends on the severity of your symptoms and pre-existing health conditions. Your surgeon will advise on the best type of surgery needed for your finger contracture.

Surgical treatment

Percutaneous Dupuytren’s needle fasciotomy
Open Dupuytren’s fasciectomy (Release)

Percutaneous Dupuytren’s needle fasciotomy

Needle fasciotomy is a particularly useful technique in patients who only have a contracture in the palm affecting the metacarpo-phalangeal (knuckle) joint. These contractures are caused by a prominent cord of tissue that arises in the palm and extends to the base of the finger. The finger can be straightened by dividing the cord of tissue using a small hypodermic needle. The diseased tissue is not removed. It is performed using local anaesthetic and may be useful for patients who might not tolerate anaesthesia so well. The main advantages of this technique include the small wound and a quick recovery. There is a higher risk of recurrence of the contracture when compared to a fasciectomy (open surgery).

Open Dupuytren’s fasciectomy (Release)

The procedure may be carried out under local, regional (injection of local anaesthetic at the neck or arm) or general anaesthetic.

The traditional operation for Dupuytren's contracture is known as a fasciectomy. The aim is to remove that part of the fascia in the palm and fingers that is causing the contracture. Although the deformity improves, there is still a risk of recurrence. Nevertheless, it is still probably the "gold standard" and most widely used treatment, especially for proximal interphalangeal joint contractures.

In specific cases (recurrent disease, an aggressive disease in younger patients) there may be an indication for a dermofasciectomy, which combines the removal of the diseased fascia with the removal of part of the overlying skin of the finger, which is then replaced with a skin graft taken from the forearm.

Aftercare

Following the surgery, a plaster cast may be applied and is kept in place until the patient sees a hand therapist a few days later. Hand therapy will be carried out to regain finger motion, and to maintain the correction by wearing a splint on the hand at night. It can take up to two months to regain finger motion and for the hand to recover from the surgery, exercises, and stretches will help to keep the finger straight and mobile.