Dupuytren's Contracture

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Jerry R. Balentine, DO, FACEP
    Jerry R. Balentine, DO, FACEP

    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

Dupuytren's contracture facts

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

What is a Dupuytren's contracture?

A Dupuytren's contracture is a localized formation of scar tissue around the tendons that flex the fingers beneath the skin of the palm of the hand. The scarring accumulates in a tissue (palmar fascia) that normally covers the tendons that pull the fingers to grip. As a Dupuytren's contracture progresses, more of the fascia becomes thickened and shortened. Dimpling and puckering of the skin over the area eventually occurs and ultimately can make it impossible to fully extend the fingers (as in laying the hand flat on a tabletop).

How fast does a Dupuytren's contracture develop?

A Dupuytren's contracture usually progresses slowly over years. In rare cases, it can progress more rapidly.

What are the causes and risk factors of a Dupuytren's contracture?

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

A Dupuytren's contracture can be inherited. In medical terms, the inherited form of a 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 a Dupuytren's 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).

Typically, a Dupuytren's contractures occur in males over the age of 50. It is more common in males of Northern European descent. The ring and little finger are affected most commonly.

Dupuytren's Contracture Treatment

Xiaflex

Xiaflex is an injectable formulation of purified collagenase derived from the bacterium, Clostridium histolyticum. It is used for treating Dupuytren's contracture. A Dupuytren's contraction is caused by an abnormal accumulation of collagen (scar) in the tissue beneath the skin of the palm of the hand. Xiaflex breaks down excessive collagen by disrupting its chemical structure.

What are the symptoms and signs of a Dupuytren's contracture?

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

As a Dupuytren's 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.

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

Is a Dupuytren's contracture limited to the hands?

Interestingly, a Dupuytren's 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 Ledderhose disease, or plantar fascial fibromatosis, and is sometimes associated with plantar fasciitis. It can sometimes be felt as a nodule or group of nodules in the middle of the sole of the foot.

Very rarely, a Dupuytren's contracture occurs in association with an uncommon scarring condition of the penis called Peyronie's disease.

How do health-care professionals diagnose a Dupuytren's contracture?

A Dupuytren's contracture is diagnosed by the doctor during the physical examination of the affected hand. X-rays and other tests are usually not necessary.

Previous burns or hand injury can lead to scar formation in the palm of the hand that can mimic true a Dupuytren's contracture.

What is the treatment for a Dupuytren's contracture?

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

Most patients with a Dupuytren's 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 a Dupuytren's contracture, when nonsurgical treatments have failed, surgical procedures can remove the scarred tissue to free the fingers and release the tendons. 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 or needle fasciotomy.

A newer treatment for a Dupuytren's contracture is collagenase (Xiaflex) injection. The scar tissue that forms the contracture is composed of a protein network called collagen. Collagenase is an enzyme that breaks up the collagen, which can then loosen the contracted tissue to restore finger mobility. Collagenase is directly injected into the contracted "cord" of scar tissue that causes the Dupuytren's contracture.

What are complications of Dupuytren's contractures?

The main complication of Dupuytren's contractures is loss of extension of the involved fingers. As a result, grasping certain objects can be limited. Occasionally, the flexed finger(s) can get in the way when using the hand, such as in dressing, etc.

Is it possible to prevent a Dupuytren's contracture?

There is no prevention method for a Dupuytren's contracture.

What is the prognosis for Dupuytren's contractures?

The outlook for the condition itself is generally good. It typically progresses very slowly. The outlook for the treatments varies, but all can be very effective.

What specialists treat Dupuytren's contractures?

Specialists that treat Dupuytren's contractures include general practitioners, orthopedic hand surgeons, plastic surgeons, and occupational therapists.

REFERENCE:

Klippel, John H., et al., eds. Primer on the Rheumatic Diseases, 13th Ed. New York: Springer and Arthritis Foundation, 2008.

Last Editorial Review: 12/3/2015

Reviewed on 12/3/2015
References
REFERENCE:

Klippel, John H., et al., eds. Primer on the Rheumatic Diseases, 13th Ed. New York: Springer and Arthritis Foundation, 2008.

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