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Dupuytren’s contracture

Definition

Dupuytren's contracture is a painless thickening and contracture of tissue beneath the skin on the palm of the hand and fingers.

Causes, incidence, and risk factors

The cause is unknown. Family history of Dupuytren's contracture makes you more likely to develop this condition. It does not seem to be caused by occupation or from trauma.

The condition becomes more common after the age of 40. Men are affected more often than women. Risk factors are alcoholism, diabetes, and smoking.

Symptoms

One or both hands may be affected. The ring finger is affected most often, followed by the little, middle, and index fingers.

A small, painless nodule or lump develops in the tissue below the skin on the palm side of the hand. Over time, it thickens into a cord-like band.

It becomes difficult to extend or straighten the fingers. In severe cases, straightening them is impossible.

Signs and tests

The health care will examine your hands. The physical examination of the palm will show thickened scar tissue and difficulty straightening the fingers.

Treatment

Exercises, warm water baths, or splints may be helpful.

Surgery may be performed to release the contracture, depending on the severity of the condition. Normal movement of the fingers is usually restored by surgery followed by physical therapy exercises for the hand.

A newer treatment involves injecting a substance called collagenase into the scarred or fibrous tissue. Three injections are needed. You may have side effects such as swelling, pain, and itching. A more rare but severe side effect is rupture of the tendon.

Expectations (prognosis)

The disorder progresses at an unpredictable rate. Surgical treatment can usually restore normal movement to the fingers. The disease can recur following surgery in up to half of cases within 10 years.

Complications

Worsening of the contracture may result in deformity and loss of function of the hand.

There is a risk of injury to blood vessels and nerves during surgery.

Calling your health care provider

Call your health care provider if you have symptoms of this disorder.

Prevention

Awareness of risk factors may allow early detection and treatment.

References

Stretanski MF. Dupuytren contracture. In: Frontera, WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 25.

Gilpin D, Coleman S, Hall S, Houston A, Karrasch J, Jones N. Injectable collagenase Clostridium histolyticum: a new nonsurgical treatment for Dupuytren's disease. J Hand Surg Am. 2010 Dec;35(12):2027-38.e1. PubMed PMID: 21134613.

Hurst LC, Badalamente MA, Hentz VR, et al; CORD I Study Group. Injectable collagenase clostridium histolyticum for Dupuytren's contracture. N Engl J Med. 2009 Sep 3;361(10):968-79. PubMed PMID: 19726771.


Review Date: 6/6/2011
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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