What You Need to Know About Dupuytren’s Contracture

Dupuytren’s contracture, sometimes referred to as Dupuytren’s disease, is a disabling hand condition that causes connective tissue under the palm to thicken and tighten. This leads one or more fingers to curl inward towards the palm. The pinky, ring, and sometimes middle finger are the digits most commonly affected by this symptom.

Symptoms

Dupuytren’s contracture usually develops very slowly over time. It could take several years for a patient to present symptoms commonly associated with Dupuytren’s contracture.

This condition begins with the skin on the palm thickening. With time, the skin may start to dimple or pucker. As Dupuytren’s advances, masses (also called nodules) begin to form under the palm. These masses aren’t typically painful, but they might be sensitive or tender for some people.

The actual deformity happens in the advanced stages of the disease, which is when cords form under the palm and extend out to the fingers. The cords begin to contract and draw the fingers in towards the palm.

Dupuytren's is usually visually recognizable by a person’s fingers being frozen in the contracted position. Daily activities that may be interrupted by this hand deformity include:

• Personal hygiene, including hand washing and face washing
• The ability to place hands in your pockets and retrieve items
• Dressing
• Picking up coins
• Wearing gloves
• Lifting and grasping large objects
• Flattening the hand to fit it into narrow spaces
• Shaking hands with someone
• Fetching money, credit cards, or ID from wallet or purse

Causes and Risk Factors

While researchers still haven’t pinpointed the exact cause of Dupuytren’s contracture, they have identified some modifiable and non-modifiable risk factors associated with developing Dupuytren’s contracture. Modifiable risk factors are those that can be changed through lifestyle and other means. Non-modifiable ones are those we are born with and cannot be changed.

Non-Modifiable Risk Factors

Dupuytren’s contracture is most common among white, Scandinavian or Northern European men who are 50 years or older. People born in the United Kingdom are also at a greater risk than people in the United States.

Men develop Dupuytren’s contracture at a rate much higher than women. Similarly, if your family members have a history of Dupuytren's contracture, you are more likely to get the condition yourself.

Modifiable Risk Factors

Smoking, especially when you smoke more than a pack a day, puts someone at an increased risk of developing Dupuytren’s contracture. Individuals who are thinner (and have a BMI that is lower than average) are also more at risk. Another habit that places someone at risk for Dupuytren's is drinking alcohol. Individuals with alcohol use disorder are especially at a high chance of developing Dupuytren's when compared to people who don't drink.

Health Risk Factors

Several health conditions are linked with an increased occurrence of Dupuytren’s contracture. Most of these health risk factors are part of a patient’s personal medical history and cannot be changed, but some that are managed well may pose little to no issue to a person's Dupuytren's. These conditions include:

• Above-average fasting blood glucose (also known as prediabetes)
• Prior hand trauma or injury, such as fractures or joint dislocations
• Ledderhose disease, which causes similar symptoms in one or both feet
• Epilepsy (though research suggests a stronger relationship between Dupuytren's and the anti-convulsive medications used to treat epilepsy)
• Diabetes
• Human immunodeficiency virus (HIV)
• History of myocardial infarction, also known as a heart attack

Diagnosis

Because of its characteristic features, Dupuytren’s is not incredibly difficult to diagnose. In most cases, doctors do not need any labs or diagnostic testing to make a diagnosis of Dupuytren’s contracture.

The initial doctor’s visit begins with a discussion about a person's family history and past medical history, as that information could help identify risk factors for Dupuytren’s contracture. Once the doctor obtains a thorough history, they will begin the physical exam. During the physical exam, they might:

• Compare the left and right hand to see what is "normal" for you and whether or not both hands are affected
• Make a note of cords and nodules on the palms and fingers
• Examine the range of motion of all the fingers
• Test the sensation throughout the hand, since Dupuytren’s can cause nerve damage
• Photograph the hands to track progression for future comparison

A common test that doctors may have patients perform is the tabletop test. This involves laying the hand flat, palm down on a table or other hard surface. If the patient cannot flatten their hand completely, this is a good indication of Dupuytren’s.

Treatment

There is still no cure for Dupuytren’s contracture, but there are several medical interventions available for treatment. There are both surgical and non-surgical interventions to choose from. A doctor can help select the best treatment option for each individual case of Dupuytren’s contracture.

Non-Surgical Interventions

In the past, non-surgical treatment options were only suitable for early stages of Dupuytren’s contracture. However, doctors and scientists developed new non-surgical interventions in recent years, so they are now capable of treating Dupuytren’s even in late stages.

Contracture cream

All natural contracture cream is an excellent option for people with beginning symptoms of Dupuytren's or those who want to try simple, at-home methods before opting for other choices. With effective ingredients that are proven to reduce inflammation and lower pain levels, this is considered a safe initial (and maybe even long-term) option for people looking to alleviate their symptoms.

Radiotherapy

Radiation therapy can be useful in the earlier stages of Dupuytren’s contracture by softening nodules to improve comfort and prevent contractures from happening. However, doctors in the United States do not often use radiation therapy for Dupuytren’s contracture due to the slight risk that radiotherapy can cause cancer.

Corticosteroid Injections

Steroid injections can be very helpful in slowing the progression of Dupuytren’s contracture. Doctors inject corticosteroids, which are anti-inflammatories, into cords to stop contractures from developing or into nodules to relieve discomfort. 

Needle Aponeurotomy

A needle aponeurotomy is a relatively new procedure that shows promising results. The doctor performs this under local anesthesia and penetrates the cords with a needle repeatedly. The idea is that the deformed tissue does not need to be removed completely but rather lengthened or released, which weakens it.

Surgical Interventions

If Dupuytren’s contracture progresses past the early stages and deformities affect someone's daily life, doctors often recommend surgery. One surgery is a fasciotomy, which is performed under local anesthesia. Once the patient is numb, the doctor uses a scalpel to make an incision into the palm and begins separating the contracted cords. During this procedure, the doctor does not remove the cords, but divides them, since this is enough to achieve motion in the affected fingers.

A subtotal palmar fasciectomy is a far more invasive surgery. The doctor makes lots of incisions along the palm and fingers, sometimes in a zig-zag pattern. The goal of subtotal palmar fasciectomy is to remove as much of the deformed tissue as possible.

Sometimes doctors leave these incisions open after surgery. Other times, they use a skin graft taken from another part of the person's body to lay over the palm and help close the wounds. Not all doctors require patients to wear splints after undergoing subtotal palmar fasciectomy. However, extensive physical therapy or occupational therapy is necessary to regain full function and range of motion in the hand that was operated on. It's important to note that, while these surgeries can be successful for some time, the rate of recurrence is 20% meaning some patients may require additional surgeries in the future.

Prognosis

While Dupuytren's can severely impact the lives of those who have it, this is not a life-threatening condition. While there is no cure for the condition, doctors and scientists have made considerable strides in advancing treatment options.

Dupuytren’s can be frustrating since it is known to recur over time. Someone may achieve the desired results after a surgery or treatment, only to have their symptoms return a year or two later. For this reason, many people require multiple surgeries and rounds of treatment over time.

Living With Dupuytren's Contracture 

While there’s no cure, there are treatments that can make living with Dupuytren’s contracture much more comfortable and reduce the likelihood of total hand deformity. It's important to look into natural options, as these can be the solution you're looking for.

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