Dupuytren’s Contracture is a condition that causes a thickening of the fibrous tissue layer underneath the skin of the palm and fingers and leads to the inability to straighten the fingers. It is often sited as being of genetic origin. (hereditary) The cause is not known. It is not caused by injury or heavy hand use.
The disease primarily affects individuals of Northern European or Scandinavian descent. (English, Irish, Scottish, French, Dutch, Swedish, Norwegian, Finnish ancestry). It is often associated with other conditions such as chronic alcoholism, epilepsy, diabetes mellitus and chronic pulmonary disease. The disease onset is usually in the fifth to seventh decade of life.
Men are more often affected than women. In most instances the ring and small fingers are affected. The disease may have a slow or rapid progression.
Dupuytren’s disease is an active cellular process in the fascia of the hand. Symptoms usually occur very gradually. It often presents as a nodule or painless lump in the palm.
The nodules may thicken and contract forming tough tendon-like bands of tissue under the skin, which are due to the pathologic change in normal fascia. One or more fingers bend (flex) toward the palm.
The ring and little fingers are most commonly affected, but any or all fingers can be involved. As the bend in the finger increases, it may become hard to straighten your finger. Activities such as wearing gloves, grasping large objects, getting items out of your pocket and shaking hands may be affected.
There is no treatment to stop or cure Dupuytren’s contracture . However it is not dangerous and it usually progresses very slowly. It may never progress beyond lumps in the palm or affect normal hand function for years.
Dupuytren's contracture does not respond to low-load prolonged stress therefore no splint is indicated for the conservative management of this disorder.
Operative treatment is indicated when your doctor has confirmed the disease is progressing and when hand function becomes limited. (grasping objects or putting hand in pocket becomes difficult).
The surgical release can be made through varied skin incisions and removal of the thickened bands to restore finger motion. Post operative hand therapy is an important adjunct to the care following surgery and is beneficial for splinting the hand in an extended position to maintain gains in motion achieved in surgery.
Hand therapy assists in gaining motion and function of the hand, aiding in controlling pain, swelling , stiffness and maximizing scar mobility. The Jacksonville Orthopedic Institute has certified hand therapists on staff at select clinics for your convenience.
This procedure may be performed in the surgeon’s office who has been trained in this technique.
A mixture of enzymes is injected into the affected area to break up the diseased tough tissue. The drug loosens the tissue and the patient returns the next day for the surgeon to numb the hand with a local anesthetic and stretch the finger to straighten it gaining motion.
After achieving gains in straightening the finger the patient is referred to Hand Therapy and instructed in stretching exercises and fitted with an extension splint to maintain extension gains.
This is a less invasive procedure done in the JOI surgeon’s office and does not involve an incision. This procedure can be done in the doctor’s office.
The surgeon numbs the hand with a local anesthetic injection and uses a hypodermic needle to divide and cut the diseased tissue in the palm and fingers.
The patient is instructed in stretching exercises and fitted with an extension splint to maintain gains.
Of note, well known people with Dupuytren’s include former US President Ronald Reagan and former British Prime Minister Margaret Thatcher.
For an appointment with a JOI MD, please call JOI-2000
By: Julia Guthart, CHT/OT