Dupuytren's contracture is a thickening and tightening of the fibrous tissue beneath the skin on the palm of the hand. The contracture causes bending of the fourth and, frequently, the fifth fingers.
Underlying the skin of the palm and fingers are strips of fibrous tissue, which are usually soft and pliable. In some people, this tissue becomes thickened and contracted, causing tight cords or nodules under the skin. The result is progressive bending of the finger, which cannot be straightened. The process starts usually at the crease on the palm of the hand, and progresses to involve the joint at the base of the finger, then the next joint of the same finger. The ring finger is most often affected, but the fifth finger is frequently involved. The condition may appear suddenly, but usually it is a slow, progressive process.
Dupuytren's contracture is common. The cause is unknown, but the condition has a genetic predisposition. It occurs most commonly in men over 45 years of age. The incidence is higher among people who are alcoholics, and people with diabetes, epilepsy, and pulmonary disease such as emphysema or chronic bronchitis. Recurrence after treatment is common.
Firm nodules or cords may be noticed beneath the skin of the palm or fingers. This is followed by progressive bending of the fingers. This condition is not painful, except in the beginning when there may be sensitivity to pressure.
Diagnosis is based on examination of the hand.
Maintaining control of diabetes, pulmonary disease, and epilepsy, and avoiding excessive alcohol may help to prevent the disease.
Progressive bending of the fingers may occur, to the point that the fingertips touch the palm of the hand.
There are no risks to others, aside from passing on the genes to offspring.
Treatment involves observation at first when the process is in the early stages. Injection of a corticosteroid medication into the nodule may help the tenderness and delay the progression of the disease. Surgery to divide the cords and remove scar tissue allows the fingers to straighten. Surgery is usually recommended when the contracture is significant or when the hand cannot be placed flat on a table.
During surgery, the small nerves and blood vessels to the fingers are at risk of injury. Bleeding under the skin may occur. Infection is possible after any operation.
After surgery, hand therapy is very important to maintain the range of motion of the fingers, regain and preserve strength, and minimize swelling.
The disease is monitored by observing for increased bending of the fingers, which indicates progression of the disease. Recurrence is common.
Author:John A.K. Davies, MD
Editor:Planko, Christa, MA
Reviewer:Donna Lester, RN, PHN, BSN, CCM
The Merck Manual, 17th Edition. Current Medical Diagnosis & Treatment 2000.