If you suffer from pain or deformity related to dupuytren’s contracture, don’t hesitate to Schedule an appointment with one of our orthopedic specialists.
Dupuytren’s contractures can form in patients with Dupuytren’s disease, which is a predisposition for the fascia tissue in the hand to become abnormal. The connective tissue or fascial tissue in the hand can form round nodules or long cords which can tighten and pull one or more fingers into a curled and bent position.
The affected fingers can’t be fully straightened, which can complicate everyday activities such as placing your hands in your pockets, putting on gloves, or shaking hands. Dupuytren’s disease is common with 8% incidence globally.1
What causes Dupuytren’s contractures?
Dupuytren’s is a hereditary disorder, with a higher incidence in populations with Northern European descent, but can be found in any people of any background. Not all family members will develop Dupuytren’s disease and those who could get varying degree of nodules or contractures. Other factors which predispose to Dupuytren’s disease include:
- Demographics: male sex, older age
- Health conditions: diabetes, seizures, smoking, alcohol use
- Hand use: repetitive injury to the hand may cause Dupuytren’s to emerge, but no good studies have proven this
- Heredity: as mentioned, heredity does play a role in Dupuytren’s disease, but symptoms can vary
- Plantar fibromatosis, or disease of the fascia of the foot, can predispose to Dupuytren’s disease of the hand
What are the symptoms of Dupuytren’s disease?
Dupuytren’s disease can present with nodules, pits or cords. Nodules are small spherical collections of fascia which are typically felt in the palm of the hand. Pits are small valleys of soft tissue that can be found next to nodules. Cords are collections of fascia which contract slowly over time and can cause fingers to become curled into the hand without the ability to fully extend them. The most common finger to be affected is the ring, followed by the small, middle, thumb and index fingers.2 Dupuytren’s contracture typically progresses over the course of several years and it is difficult to predict how quickly and how severe the contractures will become.
Diagnosis of Dupuytren’s Contractures
Dupuytren’s disease is most often diagnosed following clinical evaluation. Typically no additional imaging or bloodwork tests are necessary.
Treatment of Dupuytren’s Contractures
Dupuytren’s disease is unpredictable and treatment must be tailored to the specific individual. If the disease progresses slowly, painlessly, and does not impact your ability to use your hands, you may not require treatment and watchful waiting may be the best course of action. Once contractures impede daily activities the treatment discussion may involve the following options:
This procedure can be done in the office or in a procedure room using local anesthetic. This technique uses a needle, inserted through your skin repeatedly, to puncture and break the cord of fascial tissue that is causing a contracture. Up to 75% of patients will experience recurrent contractures at 5 years and incomplete straightening of the finger(s) is common.3
An FDA approved medication Xiaflex (collagenase clostridium histolytic) is an enzyme that can be injected into the cord. Xiaflex works by digesting the collagen proteins that make up the cord over a period of several days, after which the surgeon will manipulate the fingers to break the cord and straighten the fingers. This injection can be done in the office with the manipulation performed under local anesthesia. Common side effects include skin tears, bruising and temporary lymph node enlargement. Recurrence of contractures up to 50%, or incomplete contracture straightening may also occur.3
A more invasive treatment option, usually reserved for advanced disease, is surgical excision of the cord(s) causing the contractures. This involves making lengthy skin incisions and carefully removing the diseased fascia from surrounding nerves, vessels and tendons and can require complex soft tissue reconstruction and skin grafting. Surgical excision offers the smallest rates of recurrence (20% at 5 years) but also has higher rates of complications and longer recovery times.3 Post-operatively physical therapy and splinting will help to achieve the best results.
If you would like to speak to an orthopedic hand and wrist specialist in the DFW metroplex, give us a call at 817-697-4038, or contact us over the web. Tele-medicine appointments are also available.
AAOS – American Academy of Orthopaedic Surgeons Dupuytren’s Disease OrthoInfo webpage. https://orthoinfo.aaos.org/en/diseases–conditions/dupuytrens-disease/
ASSH- American Society of Hand Surgery Dupuytren’s Contracture webpage. https://www.assh.org/handcare/condition/dupuytrens-contracture
- “The worldwide prevalence of Dupuytren disease: a comprehensive systematic review and meta-analysis” by Nader Salari et al published in the Journal of Orthopedic Surgical Research in Oct 2020. https://pubmed.ncbi.nlm.nih.gov/33115483/
- “Epidemiological analysis of patients with Dupuytren’s disease” by Henrique Gonçalves Mansur et al published in the Rev Bras Ortop Journal Jan-Feb 2018. https://pubmed.ncbi.nlm.nih.gov/29367900/
- “Dupuytren’s disease: where do we stand?” By Rita Grazina et al in EFORT Open Rev Journal Feb 2019. https://pubmed.ncbi.nlm.nih.gov/30931150/