Dupuytren's contracture

Page last reviewed: 13/07/2011

Dupuytren's contracture is a condition that affects the hands and fingers. It causes one or more of the fingers (on one or both hands) to bend into the palm of the hand.

Dupuytren's contracture is named after the French surgeon, Baron Guillaume Dupuytren, who first described and researched the condition in 1834.

Dupuytren's contracture occurs when nodules (small growths or lumps of tissue) appear in the connective tissue of the palm, under the skin. Over time, the nodules can grow into cords of contracted (shortened) tissue. As the tissue contracts, it becomes difficult to fully extend the finger, which eventually becomes permanently fixed in a flexed (bent) position.

How common is Dupuytren's contracture?

Dupuytren's contracture is a fairly common condition. It tends to affect more men than women, and often occurs in later life. It can affect up to 20% of men above 60, and 20% of women who are over 80 years old.

Dupuytren's contracture is most commonly found in white Europeans, and it is believed to run in families. Other factors, such as heavy smoking, have been linked to the condition, but the exact cause is still unknown. 

Outlook

Dupuytren's contracture is benign (non-cancerous). The symptoms are often mild and painless and do not require treatment. However, it is a progressive condition that gets worse over time. If one or more fingers become permanently bent, it can make daily activities, such as buttoning up a shirt, difficult.

Surgery can release the contracted finger. The affected tissue can be cut to relieve the tension in the finger, or the tissue can be removed completely.

In some cases, the chance of Dupuytren's contracture reoccurring after surgery is as high as 50%. However, more extensive surgery is possible if the condition returns. Further treatments are currently being researched.

Benign
Benign refers to a condition that should not become life-threatening. In relation to tumours, benign means not cancerous.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Page last reviewed: 13/07/2011

The main symptoms of Dupuytren's contracture are small nodules (growths or lumps of tissue) on the palm of your hand. Go and see your GP if you notice:

  • any unusual lumps or dimples on your palm
  • any changes or thickening in the skin on your palm
  • any tenderness (soreness)
  • that you cannot extend (straighten) your fingers as much as you used to

Connective tissue

The lumps that occur in Dupuytren's contracture are caused by a thickening of the connective tissue, which is located just under your skin, above the tendons of your fingers. Connective tissue is made up of fibres. It acts as a framework or support for other tissues and organs in your body. 

Fibrous structures

Dupuytren's contracture causes two fibrous structures to grow in the connective tissue in your hand. These are:

  • nodules - a small lump of tissue containing fibroblasts (cells that make and release collagen)
  • cords - a band of contracted (shortened) fibrotic tissue that contains collagen

Collagen is a fibrous protein that is used to make your bones, skin and tendons. It is also present in your connective tissue to give it strength and flexibility. 

When nodules begin to form, they produce too much collagen in your connective tissue. This causes the small hard lumps that characterise Dupuytren's contracture.

Over time, usually several years, the nodules can form a cord in your hand. As the cord forms, it contracts the connective tissue in your hand, making it harder for you to extend your finger completely.

Progression

As Dupuytren's contracture progresses, your fingers may eventually be pulled into a permanently flexed (bent) position.

This can make it difficult to perform simple activities, such as swimming, playing a guitar or shaking someone's hand. The ring finger is normally affected first, followed by the little finger, then the middle finger.

Most research has found that a similar number of right or left hands are affected by Dupuytren's contracture. It is not related to whether you are left- or right-handed. In around 45% of cases, both hands are affected. In rare cases, the condition also affects the toes and soles of the feet.

Page last reviewed: 13/07/2011

No one really knows what causes Dupuytren's contracture. However, several factors have been identified that make the condition more likely. The most common factor is genetics. Up to 70% of people who develop Dupuytren's contracture have a family history of the condition.

Genetics

The gene (a unit of genetic material that determines your body's characteristics) that causes Dupuytren's contracture is passed to you from your parents. Dupuytren's condition is an autosomal dominant disorder. This means that you only need to inherit the gene that causes it from one of your parents, rather than both of them, for you to get the condition.

Other factors that make the condition more common include:

  • being male - one study found that the condition affected seven times more men than women
  • being over 40 years old - nearly 80% of people with Dupuytren's contracture are between 40-70 years old 
  • being of white northern European ethnicity - the condition is much less common among other ethnicities.

Other contributing factors

A number of other factors that are slightly more common among people with Dupuytren's contracture have been identified. However, it is not known whether these actually cause Dupuytren's contracture, or increase the risk of developing it. They include:

 

  • cirrhosis of the liver- the healthy tissue of the liver is destroyed and replaced by scar tissue
  • diabetes mellitus- a long-term condition that is caused by too much sugar in the blood
  • epilepsy - a condition that causes seizures (fits)
  • heavy alcohol use
  • heavy smoking

Dupuytren's contracture may possibly be linked to manual work or using vibrating tools. However, there is no evidence to confirm this. It is also thought that the condition may be triggered if you injure your hand and the wound does not heal correctly.

Page last reviewed: 13/07/2011

In diagnosing Dupuytren's contracture, your GP or specialist will examine your skin for the characteristic signs of the condition. These are:

  • nodules (lumps of tissue)
  • dimples or pitted marks
  • thickened skin
  • flexed (bent) fingers

The condition affects everyone differently, so you will be asked about any specific symptoms and problems in carrying out daily activities. Some people are troubled by quite a minor deformity, while others can cope with a greater one.

Deformed joints

If your finger is curling into your palm, the amount of deformity will be measured. This is measured in degrees at each joint of your finger to see how bent it is. Your fingers have three joints:

  • the distal interphalangeal - the joint before your fingernail at the top of your finger
  • the proximal interphalangeal - the middle joint half way down your finger
  • the metacarpophalangeal - the big knuckle where your finger joins your hand

Once the finger bends more than 30 degrees at a joint, most people start to have significant difficulty with activities such as shaking hands, washing their face, pushing doors, getting items out of their pockets, and putting their hand flat on a table top.

Surgery is usually recommended if the contraction is causing the metacarpophalangeal joint to bend more than 40 degrees, or the proximal interphalangeal joint to bend more than 20 degrees.

Page last reviewed: 13/07/2011

Hand therapy

After having hand surgery for Dupuytren's contracture, you may need specialised hand therapy to improve the function of your hand. This should be discussed with your specialist before the surgery. The type of therapy you may need could include:

  • physiotherapy,
  • which can involve manipulation, massage, exercise, electrotherapy and hydrotherapy to improve your range of movement
  • occupational therapy - if you are struggling with everyday tasks and activities, either at work or at home, an occupational therapist will give you practical support to make those tasks easier

How long your treatment lasts, and how often you have appointments, will depend on how extensive your surgery was. For a fasciectomy, you may need hand therapy for up to six months.

Splinting

After having surgery, your hand may be put in a splint. Initially, splinting may be recommended all day, before being used at night only. Gradually, it will not be used at all. Splinting usually involves bandaging your fingers to a plastic strip while they are in the straightest position that you find comfortable.

Currently, the use of splints is not a standard procedure. Some doctors prefer not to use them at all. When they are used, there is wide variation in the length of time they are used for, the position of your fingers, and how much force is used to keep your fingers straight.

Some doctors believe that splints can positively influence the way that scar tissue forms after surgery, so that the scar does not contract and cause the condition to return. Other doctors believe that splints cause unnecessary pain, joint stiffness and oedema (swelling), so they prefer not to use them.

Research into the use of splints is quite limited. A trial is currently underway to compare the effects of splints used after surgery with hand therapy, against the effects of just hand therapy alone. This will hopefully establish whether splints improve hand function, range of movement and the risk of Dupuytren's contracture reoccurring.  

Will the condition return?

Dupytren's contracture can return to the same spot on the hand, or it may reappear somewhere else. Recurrence is more likely if you are younger, if your contracture was severe, or if you have a strong family history of the condition. The experience of the surgeon may also influence the chance of recurrence.

After a needle fasciotomy, the recurrence rate can be as high as 50%. After a fasciectomy, this decreases to 35%. For dermofasciectomy, the recurrence rate can be as low as 8%.

When can I start driving again?

You can start driving as soon as you feel confident enough to control the car safely. This is usually after about three weeks, but it may be longer if you have had a skin graft.

When can I go back to work and sport?

This depends on your job and on the type of operation that you have had. Someone who does heavy manual work may not be able to return to work for six weeks after having a skin graft. An office worker may be able to return to light duties a few days after having a fasciotomy. The same advice applies to sport.

If you are struggling to do everyday activities, hand therapy may help to improve the range of movement in your hand. Speak to you therapist (if you have one) or your GP if you think this may benefit you.

Can the condition be prevented?

As the cause of Dupuytren's contracture is unknown, it is difficult to prevent. If you are at risk of getting the condition - for example, if you have had it before, or you have a family history of it - reducing your alcohol intake and stopping smoking (if you smoke) may reduce your risk of developing it.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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