Dupuytren's Contracture

What is it?

Dupuytren's disease is an abnormal scarring and contracture of the palm and fingers. It is called Dupuytren's disease after Baron Dupuytren who first diagnosed and operated on a case of this problem almost 200 years ago.

In the palm and fingers there is a layer of fibrous tissue called fascia. This layer is present in all hands. The fascia covers most of the palm and extends almost to the ends of the fingers. The fascia normally has thick and thin areas allowing the fingers to flex and extend. It also goes deep into the palm and connects out to the skin. This layer helps keep the palmar skin tight.

Patients' with Dupuytren's disease develop an abnormal scarring of this layer of fascia. The fascia grows into knots or nodules most frequently in the palm. These nodules can also be in the fingers. The nodules frequently join with disease out into the fingers – when this happens, it is called a cord.

What are the symptoms?

The symptoms of Dupuytren's disease are different depending on the stage of the disease. Early in the course of Dupuytren's disease, patient's present with nodules in their palms. These nodules may be sore at rest and even painful with gripping activities.

If the disease progresses into cords; the patient presents with contractures (bending) of the fingers. The little and ring fingers are the most commonly affected, but this may occur in any finger. The contracture of the fingers begins to affect the daily activities such as shaking hands, reaching into a pocket, labor, as well as crafts and hobbies. This effect is mainly due to the inability to straighten the fingers.

How is it evaluated?

The diagnosis of Dupuytren's disease is usually made by physical examination. The palpable nodule and cords are usually easy to feel and distinguish from other diseases. X-rays are usually not required to make the diagnosis. They may be added to evaluate the joints prior to surgery if needed.

What is the natural progression of the disease?

The first problem is usually a small nodule in the palm. This will usually progress to a cord extending into the fingers and eventually to a contracture. However, the timing of this is extremely variable and may take many-many years to develop.

How is it treated?

We have significant expertise in all manner of treatments for Dupuytrens disease.  Limited incision fasciotomy, percutaneous aponeurotomy (or needle aponeurotomy) and collagenase injection (Xiaflex) are useful treatment alternatives for treatment of Dupuytrens disease.   For some more complicated cases traditional fasciectomy is necessary and in severe cases a combined method of treatments may be necessary to treat this difficult condition.

Percutaneous Aponeurotomy (Needle Aponeurotomy) and Limited Incision Aponeurotomy
These procedures are usually done in a procedure room under local anesthesia and involve small, strategically placed incisions or the use of a fine needle to puncture and  disrupt the formed cords that characterize Dupuytrens disease.  Often done in conjunction with digital manipulation these two procedures can offer significant correction, low risk of complication and an accelerated rehabilitation program for patients.

Collagenase injection
The injection of collagenase (Xiaflex) into Dupuytrens cords is another useful treatment that combines an injection and then manipulation to dissolve a segment of a cord in an effort to  gain correction  in finger extension .  While this can take up to 3 injections, most often significant correction is often obtained after a single injection and staged manipulation.  Xiaflex injections and manipulations are usually  done in the office. 

In addition to offering these surgical and office based treatments our occupational hand therapists are skilled in the after care that is often necessary after these procedures.    Our certified hand therapists are available to for fabrication of splints, range of motion exercises, stretching and the application of modalities to the hand.