What is Dupuytren's Contracture?
Dupuytren's contracture is a progressive hand condition that occurs when the connective tissue in the palm becomes abnormally thickened. Over time, this thickened tissue forms cords that pull one or more fingers toward the palm, resulting in a finger contracture. This makes it difficult to straighten the affected fingers, limiting hand function and interfering with daily tasks such as shaking hands, typing, or grasping large objects.
This condition, also called Dupuytren's disease, usually affects the ring finger and little finger, though the middle finger may also be involved. The thumb and index finger are rarely affected. Many patients first notice small lumps or nodules in the palm side of the hand, which can feel tender before thick cords begin to form.
Causes and Risk Factors of Dupuytren's Contracture
The exact cause of Dupuytren's contracture is unknown, but the condition is linked to an overproduction of collagen. Excess collagen deposits in the palm form nodules and tough cords of abnormal tissue.
Several risk factors increase the likelihood of developing the disease:
- Age: Most common after age 40
- Gender: More frequent in men
- Ancestry: People of northern European descent or Scandinavian heritage are at higher risk
- Family history: The condition often runs in families
- Tobacco and alcohol use: Smoking and drinking alcohol are both risk factors
- Medical history: Conditions such as diabetes, liver cirrhosis, or seizure disorders increase the likelihood of Dupuytren's contracture
Symptoms of Dupuytren's Contracture
Dupuytren contracture symptoms usually progress slowly over months or years, but some patients experience rapid changes. Common symptoms include:
- Small lumps or nodules form in the palm side of the hand
- Thick cords of tissue pulling fingers into a bent position
- Difficulty straightening the fingers or spreading them apart
- Trouble trying to grasp large objects or place the hand flat on a table
- In severe cases, the finger contracture may extend into the proximal interphalangeal joint, limiting overall range of motion
Unlike many other hand conditions, Dupuytren's disease is often not painful, though the nodules may feel tender in early stages.
Diagnosis of Dupuytren's Contracture
Diagnosis usually requires only a physical examination and medical history. An orthopedic hand surgeon will carefully examine the hand, checking for thickened tissue, nodules, or cords. Special tests and imaging are rarely needed.
The surgeon may assess how far the affected fingers can straighten and whether the contracture is interfering with daily life activities.
Nonsurgical Treatment Options
In early stages, patients may not require surgery. Nonsurgical treatment can reduce discomfort and slow progression:
- Heat and massage: Helps loosen the tissue before stretching
- Exercises: Gentle stretching to maintain mobility and delay hand contracture progression
- Steroid injections: Reduce inflammation in the nodules
- Collagenase injections (collagenase treatment): Medication injected into the cord breaks down excess collagen. After the injection, the physician manipulates the finger to release the contracture
- Needle aponeurotomy (needle fasciotomy): A single procedure in which a needle is used to divide and weaken the cords under local anesthetic or with ultrasound guidance
Other treatment options include splinting, radiation therapy for early nodules, and physical therapy exercises after interventions to restore range of motion.
Surgical Treatment Options
When several treatments fail or the condition severely limits function, patients may require surgical treatment. Dupuytren's contracture surgery aims to remove diseased tissue and restore finger extension.
Common surgical treatment options include:
- Fasciectomy: Removal of diseased cords and nodules
- Dermofasciectomy with skin graft: Diseased tissue is removed and replaced with a skin graft to reduce recurrence
- Dupuytren's surgery under local anesthesia or regional anesthesia on an outpatient basis
During surgery, the surgeon makes an incision in the palm, carefully removes the thickened tissue, and protects nearby blood vessels and nerves. The surgical site is then closed with sutures and dressed. In severe cases, surgery provides the best course for restoring hand function.
Recovery After Surgery
Recovery varies, but most patients benefit from physical therapy after surgery. Therapy helps restore motion, strength, and flexibility while reducing scar tissue formation. Some patients may require splints to maintain extension.
While surgery improves function, recurrence of Dupuytren's cords is possible. The long-term outlook depends on the extent of disease and overall health.
Possible Risks of Surgery
Like any surgical procedure, there are possible risks:
- Infection at the surgical site
- Nerve injury leading to weakness, numbness, or paralysis
- Injury to blood vessels in the hand
- Recurrence of the disease
- Delayed healing or scarring
- Need for additional procedures, such as a skin graft
Despite these risks, many patients experience improved mobility and reduced contracture after surgery.
Everyday Life With Dupuytren's Disease
Patients with Dupuytren's disease may adapt well in early stages, but progression can interfere with essential activities like writing, dressing, or cooking. With nonsurgical treatment or dupuytren's contracture surgery, many patients regain independence and function.
Working with experienced orthopedic hand surgeons ensures that each patient receives the most appropriate care, whether that means collagenase injections, needle fasciotomy, or surgery.
Why Choose Dr. Neustein for Dupuytren's Contracture Treatment?
Dr. Thomas Neustein is a fellowship-trained, board-certified orthopedic hand and upper extremity surgeon. He specializes in treating conditions such as Dupuytren's contracture with advanced surgical treatment options and personalized nonsurgical treatment. Patients trust him to deliver safe, effective care tailored to their lifestyle and goals.
If you are experiencing difficulty straightening your fingers, small lumps in the palm, or signs of hand contracture, Dr. Neustein can help determine the best course of treatment.
Schedule an Appointment Today
Dupuytren's contracture can worsen over time if left untreated. Whether you are in Duluth, Dawsonville, or Braselton, help is available close to home. Schedule an appointment with Dr. Neustein today to explore your treatment options and improve your hand function.
