Dupuytren Contracture: Symptoms, Causes, Treatment

What are the symptoms of Dupuytren contracture?

Dupuytren contracture is a condition that affects the connective tissue under the skin of the palm and fingers, causing the fingers to curl inward. The symptoms of Dupuytren contracture typically develop gradually and may include:

1. Nodules: Small, firm lumps (nodules) may form in the palm. These nodules are usually painless initially but can sometimes be tender or sore.
2. Puckering or dimpling of the skin: As the condition progresses, the skin of the palm may appear puckered or dimpled.
3. Thickened cords: Over time, the nodules can develop into thickened cords of tissue that extend from the palm into the fingers. These cords can be felt under the skin and may restrict finger movement.
4. Finger contracture: The most characteristic symptom of Dupuytren contracture is the curling of one or more fingers towards the palm, making it difficult or impossible to fully straighten the affected fingers. The ring finger and little finger are most commonly affected, but any finger can be involved.
5. Difficulty with hand function: As the fingers curl inward, hand function can be impaired, making it challenging to perform everyday tasks such as grasping objects, shaking hands, or putting on gloves.
6. Loss of grip strength: The contracture can lead to a reduction in grip strength and dexterity, affecting the ability to hold or manipulate objects.

Dupuytren contracture typically progresses slowly, and not all individuals with the condition will experience severe symptoms or significant functional impairment. If you notice any of these symptoms, it’s important to see a healthcare provider for evaluation and potential treatment. Early intervention can help manage symptoms and prevent further progression of the condition.

What are the causes of Dupuytren contracture?

The exact cause of Dupuytren contracture is not fully understood, but several factors are thought to contribute to its development. These include genetic, environmental, and lifestyle factors:

1. Genetics: Dupuytren contracture often runs in families, suggesting a strong genetic component. It is more common in people of Northern European descent and is sometimes referred to as “Viking disease.”
2. Age: The condition is more common in individuals over the age of 50.
3. Gender: Men are more likely to develop Dupuytren contracture than women, and men tend to have more severe cases.
4. Diabetes: People with diabetes have an increased risk of developing Dupuytren contracture.
5. Alcohol consumption: Excessive alcohol consumption has been associated with an increased risk of developing the condition.
6. Smoking: Smoking is a risk factor for Dupuytren contracture, possibly due to its effects on blood vessels and tissue health.
7. Trauma or injury: Some studies suggest that hand trauma or injuries may trigger the development of Dupuytren contracture in predisposed individuals, although this is not a definitive cause.
8. Other medical conditions: Dupuytren contracture has been associated with certain medical conditions, such as epilepsy, thyroid disease, and liver disease.
9. Occupational factors: Some evidence suggests that manual labor, especially work involving repetitive hand use or vibration, may be linked to a higher risk of developing Dupuytren contracture, although this connection is not well established.

While these factors can increase the likelihood of developing Dupuytren contracture, not everyone with these risk factors will develop the condition. Conversely, some people without any known risk factors may still develop it. The interplay of genetic predisposition and environmental factors likely contributes to the development and progression of Dupuytren contracture.

How is Dupuytren contracture diagnosed?

Diagnosis of Dupuytren contracture is primarily based on a physical examination and the patient’s medical history. Here are the steps typically involved in diagnosing this condition:

1. Medical History: The healthcare provider will take a detailed medical history, asking about symptoms, their onset, and any family history of Dupuytren contracture or related conditions. They may also inquire about other risk factors, such as diabetes, alcohol consumption, and smoking.
2. Physical Examination:

• Inspection: The provider will inspect the hands for signs of nodules, skin puckering, or dimpling in the palm.
• Palpation: The provider will palpate (feel) the palm and fingers to identify any firm nodules or thickened cords of tissue beneath the skin.
• Range of Motion: The provider will assess the range of motion of the fingers, checking for any difficulty in straightening the fingers fully. They may ask the patient to place their hand flat on a table to see if the fingers can be fully extended.

1. Functional Assessment: The provider may evaluate how the condition affects hand function, such as grip strength and the ability to perform tasks like grasping objects or shaking hands.
2. Tabletop Test: This is a simple test where the patient is asked to place their hand flat on a table. If they cannot lay their hand completely flat, it suggests the presence of contracture.

In most cases, these steps are sufficient to diagnose Dupuytren contracture. Additional tests, such as imaging studies (e.g., X-rays, ultrasound, or MRI), are typically not necessary but may be used if the diagnosis is unclear or if there are concerns about other conditions.

If Dupuytren contracture is diagnosed, the healthcare provider will discuss the severity of the condition and potential treatment options based on the patient’s symptoms and the impact on hand function.

What is the treatment for Dupuytren contracture?

Dupuytren contracture is a condition characterized by thickening of the skin and underlying tissues on the palmar surface of the hand, leading to flexion of the fingers. The treatment for Dupuytren contracture depends on the severity of the condition and the degree of finger flexion. Here are some common treatment options:

1. Observation: Mild cases may not require treatment, and the condition may stabilize or even regress over time.
2. Non-surgical treatments:
   • Corticosteroid injections: Injecting corticosteroids into the affected area can help reduce inflammation and slow down the progression of the condition.
   • Needle fasciotomy: This involves using a needle to break up the cord-like tissue that causes the contracture.
   • Physical therapy: Exercises and stretching can help maintain finger mobility and strength.
3. Surgical treatments:
   • Fasciectomy: This is the most common surgical procedure, where the diseased tissue is removed surgically.
   • Open fasciotomy: A surgical procedure where a incision is made to release the tight tissue.
   • Collagenase clostridium histolyticum (CCH): A nonsurgical procedure that uses an enzyme to break down the collagen in the affected tissue, allowing for finger straightening.
4. Alternative therapies:
   • Radiotherapy: Some studies suggest that low-dose radiotherapy may help slow down the progression of Dupuytren contracture.
   • Ultrasound therapy: High-intensity focused ultrasound therapy has been shown to reduce symptoms and improve finger mobility.

The decision to pursue treatment depends on several factors, including:

• Severity of symptoms
• Degree of finger flexion
• Impact on daily activities
• Presence of other health conditions

It’s essential to consult with a healthcare provider or a hand surgeon to determine the best course of treatment for your specific case.