Dupuytren Contracture

What is Dupuytren contracture?

Dupuytren contracture (sometimes also called Dupuytren disease) is a genetic disorder that makes the tissue under the skin of your palms and fingers thicken and tighten. Small bumps (nodules) grow on your hand’s fascia — the rubber-band like tissue under your skin that supports your hand and fingers. Eventually, these growths can form thick cords under your skin and bend your fingers so much that you can’t straighten them.

The growths that cause Dupuytren contracture are always benign, which means they’re never a symptom (or cause) of cancer. You might need surgery, but many cases can be managed with more conservative treatments.

Who does Dupuytren contracture affect?

Dupuytren contracture can affect anyone. Some people are more likely to develop it, including:

• Males.
• People of European descent.
• People with a family member who’s had it.

Dupuytren contracture and other conditions

People with certain diseases or health conditions may be more likely to develop Dupuytren contracture, including:

• Diabetes.
• Epilepsy and other seizure disorders.
• Alcohol use disorder (formerly known as alcoholism).
• HIV and AIDS.
• Vascular disease.

How common is Dupuytren contracture?

Dupuytren contracture is rare. Around 5% of people experience it. People of European descent are much more likely to develop Dupuytren contracture than people from other ethnic backgrounds.

How does Dupuytren contracture affect my body?

Dupuytren contracture might never affect your body in a way you notice. If you have mild symptoms, you may never even know you have it. Even if you do have symptoms, it usually takes a long time (months or years) for them to progress (get worse). In later stages, it might be hard — or impossible — to straighten your affected fingers.

Dupuytren contracture can affect any of your fingers — including your thumb. It’s most common in people’s fingers in the following order:

• Ring (fourth finger).
• Pinkie (fifth finger).
• Middle (third finger).
• Index (second finger).
• Thumb (first finger).

Can Dupuytren contracture affect other parts of the body?

Dupuytren contracture can only affect your hands. It can’t develop in other parts of your body. Even though it’s related to other connective tissue disorders that can develop in other places in your body, you’ll never develop Dupuytren contracture anywhere other than your hands.

Some people with Dupuytren contracture are more likely to experience similar conditions like Ledderhose disease and Peyronie’s disease.

What are the symptoms of Dupuytren contracture?

Dupuytren contracture can take months or even years to develop, so you might not notice any symptoms at first. Symptoms of Dupuytren contracture usually develop in the following order:

• Nodules: Small bumps under the skin on your palm are the first sign of Dupuytren contracture. They’re usually at the base of your fingers where they meet your palm. You might be able to feel or seem them. Some people never get symptoms beyond nodules, and some people’s nodules go away on their own. The nodules might make the skin around them look dimpled or puckered.
• Cords: Over time, the nodules may thicken into long cords of tissue on your fascia. The cords can pull on your fingers and make it feel like they’re constantly being pulled in, toward you palm.
• Contracture: The most advanced symptom is what gives Dupuytren contracture its name. Eventually, the cords can grow so tight and thick it might be impossible for you to extend or straighten your affected fingers away from your palm.

Unlike other conditions, there aren’t usually triggers that aggravate Dupuytren contracture’s symptoms. If you have it, your symptoms may slowly get worse over time as nodules turn into cords and then might cause contracture. Some people never progress through all stages of symptoms.

Additional symptoms

In addition to the issues with your fingers, you might have the following symptoms in your affected hand:

• Inflammation or swelling.
• Tenderness.
• Pain or burning.
• Itching.

These symptoms are rare. Only around one-quarter of people with Dupuytren contracture will experience them. Talk to your provider if you have Dupuytren contracture and you experience these symptoms — they can sometimes be a sign of other issues that can affect your skin or fascia.

What causes Dupuytren contracture?

Experts aren’t sure what causes Dupuytren contracture. It’s considered a genetic disorder because it’s been proven that you’re much more likely to develop Dupuytren contracture if one of your family members has had it.

Dupuytren contracture is the most common inherited disorder that affects connective tissue.

How is Dupuytren contracture diagnosed?

A healthcare provider will diagnose Dupuytren contracture with a physical exam of your hand. They’ll look at your hand and fingers, feel for nodules and cords under your skin and measure how severe your contracture may be.

Which tests will be done to diagnose Dupuytren contracture?

There aren’t any special tests used to diagnose Dupuytren contracture. Your provider may order blood tests or X-rays to check for other conditions that can affect your hands.

How is Dupuytren contracture treated?

Your provider will treat your Dupuytren contracture in several stages, depending on how severe your symptoms are.

Because Dupuytren contracture develops so slowly, it might take months or years for you to need the next level of treatment. Your symptoms might also be resolved with early treatments, and you’ll never need additional options. You might need to repeat some steps of treatment if your early symptoms recur (come back).

Conservative treatment

Conservative treatments for Dupuytren contracture include:

• Physical therapy or stretching exercises.
• Bracing or splinting to stretch your fingers to their usual range of motion (how far you can move them).
• Ultrasonic (painless sound waves) or heat treatments to increase your fascia’s flexibility.
• Corticosteroid injections to shrink nodules and cords.

Radiation Therapy

Your provider may refer you to a radiation specialist to help treat Dupuytren contracture or prevent your symptoms from progressing. Radiation therapy is a painless procedure that involves using X-rays or other beams aimed at the nodules or cords to soften them.

Radiation therapy is used to treat some types of cancer. But Dupuytren contracture isn’t cancer, and having it doesn’t mean you have (or will develop) cancer.

Needle aponeurotomy

If your symptoms haven’t improved after a few months of conservative treatments, your provider might recommend needle aponeurotomy. This procedure is sometimes called a percutaneous needle fasciotomy. Needle aponeurotomy is an outpatient procedure your provider can perform in their office.

Your provider will numb your hand with a local anesthetic, then poke holes in your hand’s fascia with a needle to release tension and straighten your fingers.

Collagenase injections

Your provider might inject collagenase into the nodules or cords to treat Dupuytren contracture. Collagenase is an enzyme that helps loosen and break down the growths on your fascia. First, your provider will inject collagenase directly into the nodules or cords. Then you’ll come back the next day and they’ll numb your hand and stretch your affected fingers back out to their original range of motion.

Dupuytren contracture surgery

If your contracture is so severe that it interferes with your quality of life, you might need surgery. Dupuytren contracture surgery is an outpatient procedure, which means you can go home the same day.

Your surgeon will perform what’s called a fasciectomy. They’ll numb your hand with a local anesthetic and then remove some or all of your affected fascia. How much they need to remove depends on how much your fascia has thickened, and how severe the contracture is. You might need physical or occupational therapy after your surgery to help your joints return to their usual strength.

Is there a cure for Dupuytren contracture?

There’s no cure for Dupuytren contracture. However, almost all cases are manageable with treatment.

Because there isn’t a cure, around 1 in 5 people develop Dupuytren contracture again, even after surgery to remove their affected fascia. If this happens, you’ll need more treatment in the future.

How can I manage the symptoms of Dupuytren contracture?

Follow the instructions your provider gives you to manage your Dupuytren contracture symptoms. If you have stretches to perform or need to wear a splint or brace, make sure to do so as often as your provider instructs.

How soon after treatment will I feel better?

How long it takes to feel better depends on how your Dupuytren contracture was treated:

• Conservative treatments sometimes take months to improve your symptoms.
• Needle aponeurotomy should improve your contracture right away.
• Surgery should relieve your symptoms, but you won’t notice the full improvement for up to two months after you recover. After surgery, you’ll need to let your hand heal. You’ll also need physical or occupational therapy for at least a few months to help your hand regain its strength and range of motion.

Talk to your provider before resuming any of your regular activities while you’re recovering.

Dupuytren contracture treatment complications

Complications of Dupuytren contracture treatment can include:

• Pain.
• Nerve damage.
• Infection.
• Scarring.
• Damage to your blood vessels.
• Wound healing problems.

How can I reduce my risk of developing Dupuytren contracture?

There’s nothing you can do to prevent Dupuytren contracture. In the same way that there’s no cure, it develops without warning. Talk to your provider if someone in your family has been diagnosed with Dupuytren contracture.

How long does Dupuytren contracture last?

Because it develops over months or years, it’s easier to think about Dupuytren contracture like a progression of symptoms you do or don’t have yet, rather than a disease that has a timeframe.

After treatment, you might re-develop Dupuytren contracture in the future. But, even if you do, your provider can treat it in the same ways they did the first time.

Will I need to miss work or school with Dupuytren contracture?

You shouldn’t have to miss work or school if you’re receiving conservative treatment for Dupuytren contracture.

If you need a needle aponeurotomy or surgery, you might need to take some time away from your job or schoolwork if you can’t do them with your hand in a brace or splint. Talk to your provider about when you can resume your normal activities after treatment.

Outlook for Dupuytren contracture

The outlook for Dupuytren contracture is positive. Dupuytren contracture is extremely treatable and slow to develop. Even though there’s no cure, there are many types of treatments available to relieve your symptoms. It’s also always benign, so Dupuytren contracture is never a symptom or cause of cancer.

How do I take care of myself?

Follow the instructions your provider gives you. Conservative treatments of Dupuytren contracture take months, so it’s important you do any stretches or other physical therapy exercises as best you can, as often as you need to.

Following your therapy guidelines is especially important if you’ve had surgery. Some studies show that up to half of surgery’s benefits come from stretching and physical therapy after the operation itself.

When should I see my healthcare provider?

If you notice your symptoms progressing (getting worse), talk to your provider. The sooner you get treatment, the more likely it is you can relieve your symptoms before they advance further.

A good way to monitor the progression of your symptoms is the tabletop test. If you place your hand with the palm facing down on a flat surface and notice that your affected fingers aren’t lying flat there’s a good chance your symptoms are progressing. See your provider for treatment.

When should I go to the ER?

Go to the emergency room if you notice any of the following:

• Extreme pain.
• Swelling.
• Discoloration.
• You can’t move your hand in ways you usually can.
• Bleeding at your surgery site.

What questions should I ask my doctor?

• Which treatments do I need?
• How long will we try conservative treatments?
• Are there any stretches I can do to help?
• Will I need surgery?

What is the difference between Dupuytren contracture and Dupuytren disease?

Healthcare providers use Dupuytren contracture and Dupuytren disease interchangeably. Some providers distinguish between them and say Dupuytren contracture (the way your hand’s fascia thickens) is a symptom of Dupuytren disease (an overall condition that causes Dupuytren contracture).

What is the difference between Dupuytren contracture and trigger finger?

Both Dupuytren contracture and trigger finger might cause one of your fingers to become stuck, flexed inward toward your palm. However, they’re very different conditions.

Dupuytren contracture is a growth and thickening of the fascia under the skin of your hand. Nodules form at the base of your fingers and thicken into cords running under your palm.

Trigger finger happens when the A1 pulley (the mechanism that controls and guides the tendons in your fingers and thumb) is inflamed. This inflammation makes moving your finger as smoothly as you’re used to difficult. People with trigger finger often feel a “catch” or bump as they bend their affected finger.

No matter what’s causing issues with your hand, talk to your healthcare provider as soon as you notice new symptoms, especially if you’re in pain or have trouble moving your hand like you usually can.