Dupuytren Contracture

What is a Dupuytren contracture?

Dupuytren contracture is a localized formation of scar tissue beneath the skin of the palm of the hand. The scarring accumulates in a tissue (fascia) that normally covers the tendons that pull the fingers to grip. As Dupuytren contracture progresses, more of the fascia becomes thickened and shortened. Dimpling and puckering of the skin over the area eventually occurs.

How fast does Dupuytren contracture develop?

Dupuytren contracture varies in its rate of progression from minor skin puckering for many years to rapid contracture (fixed flexed position) of fingers.

What are the causes of Dupuytren contracture?

The precise cause of Dupuytren contracture is not known. However, it is known that it occurs more frequently in patients with diabetes mellitus,seizure disorders (epilepsy), and alcoholism.

Dupuytren's contracture can be inherited. In medical terms, the inherited form of Dupuytren's contracture is transferred in the family as a so-called autosomal dominant trait with incomplete penetrance and partial sex-limitation. This means that the gene for Dupuytren contracture is not on an X or Y chromosome (sex chromosome) but on one of the other 44 chromosomes. Consequently, one version of the gene is enough to cause the disorder (it is dominant), but not everyone who has the gene has the disorder (the gene is not fully penetrant) and the disorder is most frequent in males (the gene expression is partially limited to males).

What are the symptoms of Dupuytren contracture?

Dupuytren contracture initially may cause only a minor painless lump in the palm of the hand near the base of the finger(s). Dupuytren contracture most commonly affects the ring (fourth) finger, but it can affect any and all fingers. Dupuytren contracture can also affect one or both hands.

As Dupuytren contracture progresses, it can lead to an inability to fully extend the affected finger from the flexed position. This can result in a loss of normal grasping.

Dupuytren contracture is seldom associated with much, if any, pain unless the affected fingers are inadvertently forcefully hyperextended.

Is Dupuytren contracture limited to the hands?

Interestingly, Dupuytren contracture is sometimes associated with inflammation and thickening of the fascia tissue in a similar manner of the sole of the foot. This condition is called plantar fasciitis. Very rarely, Dupuytren contracture occurs in association with an uncommon scarring condition of the penis, called Peyronie's disease.

How is Dupuytren contracture diagnosed?

Dupuytren's contracture is diagnosed by the doctor during the physical examination of the affected hand.

Previous burns or hand injury can lead to scar formation in the palm of the hand which can mimic true Dupuytren contracture.

How is Dupuytren contracture treated?

The treatment of Dupuytren contracture depends on the severity and the underlying condition of the affected individual.

Most patients with Dupuytren contracture require reassurance and stretching exercises with heat application. When the palm is persistently sore with grasping, ultrasound treatments can be helpful. Sometimes local inflammation is best relieved with cortisone injection.

For patients with significant fixed flexed posture (contracture) of the fingers from Dupuytren contracture, surgical procedures can remove the scarred tissue to free the fingers. These procedures can return function to a disabled hand. Minor nodule formation and/or skin thickening of the palm is not a reason to operate. Sometimes the surgeon can release the scarred tissue by carefully cutting it with a needle. This procedure is referred to as a needle aponeurotomy.

Dupuytren Contracture At A Glance

• Dupuytren contracture is a localized scar tissue formation in the palm.
• The precise cause of Dupuytren contracture is not known.
• Dupuytren contracture is sometimes inherited.
• Dupuytren contracture can limit extension of the affected finger.
• The treatment of Dupuytren contracture depends on the severity and the underlying condition of the affected individual. Treatments include stretching, heat, ultrasound, local cortisone injection, and surgical procedures.