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Dupuytrens contracture

Dupuytrens contracture is a painless thickening and tightening (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 Dupuytrens contracture makes you more likely to develop this condition. It does not seem to be caused by occupation or from trauma.

The condition is more common after age 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 doctor will examine your hands. Diagnosis can usually be made from the telltale signs of Dupuytrens contracture. Other tests are rarely needed.

Treatment

Your doctor may recommend exercises, warm water baths, or splints.

Surgery may be done to release the contracture. 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

Gilpin D, Coleman S, Hall S, et al. Injectable collagenase Clostridium histolyticum: a new nonsurgical treatment for Dupuytren's disease. J Hand Surg Am. 2010;35:2027-2038.

Hurst L. Dupuytren’s contracture. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, eds. Green’s Operative Hand Surgery. 6th ed. Philadelphia, Pa.: Elsevier Churchill-Livingston;  2010:chap 5.

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

Updated: 4/16/2013

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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