Also known as Dupuytren's contracture, this hand condition involves a shortening of the fibrous tissue layer in your palm and fingers. As this tissue thickens and contracts, it may pull on your fingers, causing them to curl inwards towards a fist shape. Dupuytren's disease may be slowly progressive, and in some individuals, may advance to the stage where the locking of the fingers in a curled position causes restricted use of the hand during daily activities.
Dupuytren’s disease is characterised by thickening and shortening of the palmar fascia, the fibrous layer of tissue that sits just under the skin in the palm of your hand and underside of the fingers. The most commonly affected fingers are the ring and pinkie fingers but it can impact any of your fingers, including the thumb.
The contraction of the fascia is driven by the overgrowth of cells commonly associated with scar tissue (myofibroblasts), though Dupuytren’s disease is not considered to involve scarring. The condition may start as little firm lumps under the skin of your palm, before thick cords running lengthwise on your palm to your fingers become noticeable. The contraction and tension of these cords can act as a tether for the associated finger, locking it in a bent position.
Dupuytren’s is twice as common in men than women, and often there will be a family history of the disease. Other risk factors for Dupuytren’s disease can include:
Although some patients experience increasing contracture as the condition progresses, at least half of individuals may find it stabilises and may sometimes even self-resolve to some degree.
As the palmar fascia of your palm thickens and contracts, you may find:
Dupuytren’s symptoms are most commonly found in both hands, though the severity may be asymmetrical. It is also possible to develop Dupuytren’s disease just in one hand.
Diagnosis of Dupuytren’s disease is usually made with a physical exam, observing the nodules or cords and testing the range of motion of your fingers. Sometimes, an X-ray may be recommended to rule out other conditions that are also known to limit finger movement, such as trigger finger.
There is no current cure for Dupuytren’s, though treatment can be offered to restore the ability of your hand to open and close normally, and slow the progression of the disease.
It is not always necessary to treat Dupuytren’s contracture if you are still content with your ability to use your hand and are not concerned about the presence of nodules or cords. Some individuals choose to just monitor the condition, particularly if it is stable and non-progressive, and is not affecting your hand function.
Non-surgical management of Dupuytren’s can include:
Splinting or forcible straightening of a finger bent by Dupuytren’s contracture is not typically recommended, as this may result in injury. In some situations, splints are used to protect the finger after surgery.
Unfortunately, Dupuytren’s disease may recur after non-surgical treatment. These interventions are designed to alleviate symptoms but the tendency for abnormal myofibroblast growth may result in the contracture returning.
Surgery for Dupuytren’s contracture may be recommended if your hand function and finger mobility are significantly affecting your ability to engage in daily tasks.
There are two surgical procedures commonly used to treat Dupuytren’s:
Because a partial palmar fasciectomy is more extensive than a fasciotomy, it is associated with longer healing times, a greater degree of scarring, and more intensive post-operative rehabilitation. However, this approach does come with a lower rate of recurrence compared to a fasciotomy and non-surgical interventions.
