Dupuytren’s Contracture

A deformity in the hand that tends to develop over time, Dupuytren’s contracture affects a layer of tissue that lies under the skin of the palm. Knots of tissue form underneath the skin of the palm that eventually creates a thick cord. This cord can tighten and pull one or more fingers into a curled, bent position.

The affected fingers can’t be straightened completely, which can complicate everyday activities such as placing your hands in your pockets, putting on gloves or shaking hands.

Symptoms

Dupuytren’s contracture typically progresses over the course of several years. The condition typically starts as a thickening of the skin on the palm of your hand. Over time, the skin on your palm might appear puckered or dimpled. 

In later stages of Dupuytren’s contracture, cords of tissue form under the skin on your palm and can extend up to your fingers. As these cords tighten, your fingers might pull inwards to the palm.

Treatment

If the disease progresses slowly, painlessly, and does not impact your ability to use your hands, you may not require treatment. Instead, you may wait and see if Dupuytren’s contracture progresses further. 

Treatment for Dupuytren’s contracture involves breaking apart the cords that pull the fingers toward your palm. This can happen several ways. 

Needling

This technique uses a needle, inserted through your skin, to puncture and break the cord of tissue that’s contracting a finger. Contractures often recur but the patients can repeat the procedure.

Enzyme injections

Injecting an enzyme into the cord can soften and weaken it — allowing your doctor to later manipulate the hand in an attempt to break the cord and straighten the fingers. The FDA has approved collagenase Clostridium histolyticum (Xiaflex) for this purpose. The advantages and disadvantages of the enzyme injection are similar to needling. Enzyme injections are not offered at all medical institutions.

Surgery

Another option for people with advanced disease, limited function and progressing disease is to surgically remove the tissue in your palm affected by the disease. The main advantage to surgery is that it results in a more complete and longer-lasting release than that provided by the needle or enzyme methods. The main disadvantages are that physical therapy is usually needed after surgery, and recovery can take longer.

In some severe cases, especially if surgery has failed to correct the problem, surgeons remove all the tissue likely to be affected by Dupuytren’s contracture, including the attached skin. In these cases a skin graft is needed to cover the open wound. This surgery is the most invasive option and has the longest recovery time. People usually require months of intensive physical therapy afterward.