Dupuytren Contracture: Causes, Symptoms and Treatment
Dupuytren contracture is a benign connective tissue disorder of the hand causing progressive finger flexion and limiting hand function.
Things worth knowing about "Dupuytren Contracture"
Dupuytren contracture is a benign connective tissue disorder of the hand causing progressive finger flexion and limiting hand function.
What Is Dupuytren Contracture?
Dupuytren contracture (also known as Dupuytren disease or palmar fibromatosis) is a benign, progressive condition affecting the connective tissue beneath the skin of the palm. Over time, the palmar fascia – a layer of fibrous tissue in the hand – thickens and tightens, forming firm nodules and cord-like bands. These cords gradually pull one or more fingers into a permanently bent position, making it impossible to fully straighten them. The ring finger and little finger are most commonly affected.
The condition typically progresses slowly over months or years and is generally painless, though it can significantly impair hand function. It is named after the French surgeon Guillaume Dupuytren, who first described it systematically in the 19th century.
Causes and Risk Factors
The exact cause of Dupuytren contracture is not yet fully understood. It is considered a multifactorial condition influenced by both genetic and environmental factors.
- Genetic predisposition: The condition runs in families and follows an autosomal dominant inheritance pattern with variable penetrance. It is most prevalent among people of Northern European descent.
- Age and sex: Men are approximately 5 to 10 times more likely to be affected than women. The risk increases significantly after the age of 40.
- Diabetes mellitus: People with diabetes have an elevated risk, though the condition often presents in a milder form.
- Alcohol consumption: Chronic alcohol use is considered a contributing risk factor.
- Epilepsy and antiepileptic medications: Certain drugs such as phenobarbital may increase the risk.
- Smoking: Nicotine use has also been discussed as a potential contributing factor.
- Manual labor: Heavy physical work with the hands may predispose individuals to the condition, although it is not considered a sole cause.
Symptoms
Dupuytren contracture develops gradually. Common signs and symptoms include:
- Small, firm nodules in the palm, typically near the base of the ring or little finger
- Palpable, rope-like cords running beneath the skin toward the fingers
- Progressive flexion contracture of one or more fingers – inability to fully extend the fingers
- Impaired hand function (e.g., difficulty shaking hands, gripping objects, or putting on gloves)
- Occasional mild itching or pressure sensitivity; pain is uncommon
The condition is often bilateral, though one hand is usually more severely affected than the other.
Diagnosis
Dupuytren contracture is primarily diagnosed through clinical examination. Imaging studies are generally not required.
- Inspection and palpation: The physician examines the hand for characteristic nodules and cords in the palm.
- Tabletop test (Hueston test): The patient is asked to place the hand flat on a table surface. Inability to do so indicates a clinically significant contracture.
- Angle measurement: The degree of flexion contracture is measured in degrees to assess severity and monitor progression over time.
Treatment
There is currently no cure for Dupuytren contracture. The goal of treatment is to restore finger extension and improve hand function. Both non-surgical and surgical options are available.
Non-Surgical Treatment
- Collagenase injection (Xiapex): A bacterial enzyme (collagenase from Clostridium histolyticum) is injected directly into the cord to dissolve it. This minimally invasive procedure can be performed on an outpatient basis.
- Needle aponeurotomy (percutaneous needle fasciotomy): A fine needle is used to puncture and divide the fibrous cord. This is a quick, minimally invasive technique with a fast recovery time.
- Radiotherapy: Low-dose radiation in early stages may slow disease progression.
Surgical Treatment
- Fasciotomy: Surgical division of the affected cord without removing tissue.
- Fasciectomy: Surgical removal of the diseased tissue. This is the most effective method with the lowest recurrence rate but requires a longer recovery and postoperative physiotherapy.
- Dermofasciectomy: Removal of the affected tissue along with the overlying skin; used in severe or recurrent cases.
Following any treatment, physiotherapy and splinting are important to maintain the results. Recurrence is possible, particularly in patients with a strong genetic predisposition.
References
- Lanting R et al. (2014): A systematic review of treatment options for Dupuytren's disease. Plastic and Reconstructive Surgery, 132(4), 1416–1424. PubMed PMID: 24076703.
- Watt AJ, Curtin CM, Hentz VR (2010): Collagenase injection as nonsurgical treatment of Dupuytren's disease: 8-year follow-up. Journal of Hand Surgery, 35(4), 534–539.
- Eaton C (2014): Evidence-based medicine: Dupuytren contracture. Plastic and Reconstructive Surgery, 133(5), 1241–1251. PubMed PMID: 24776572.
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