Dupuytren’s contracture is a lesser-known condition of the hand causing the fingers to remain in a permanently bent position. It is pronounced as “du-pwe-TRANZ,” and is typically seen most commonly in older men and women of European and Viking descent. It was first named in honor of Guillaume Dupuytren in the 19th century, but historical records show it present in the 12th and 13th centuries.
This condition is sometimes painful for patients, and it typically affects the ring and small fingers, and less commonly the thumb.
Cause and Diagnosis
The condition is caused by excessive facial tissue underneath the skin. It is first noticed as a lump or a knot as the tissues thicken, and this causes the fingers to bend in a permanently flexed position. The thickening can occur in one spot as a lump (also called a nodule), or it can become more extensive, which is felt like a cord. This bending happens over a period of several months to years. This can make simple tasks like wearing gloves, typing on a computer, buttoning a coat, turning a doorknob, or shaking hands to be very difficult.
The experienced Long Island plastic surgeons at Cold Spring Plastic Surgery will assess for thickening or nodules of the skin on the palm of your hand. Dupuytren’s contracture is not a contagious disease, but there may be a genetic link passed down from parents or grandparents. Excessive alcohol intake and diabetes may make this condition worse.
When considering treatment options, they will vary depending on the severity of the condition of the hand. It is essential to weigh the benefits as well as the possible adverse outcomes of the treatment.
This technique uses a small needle to poke holes into the affected area. The patient is given local anesthesia to numb the area, and a small needle is used to break the cord or nodule that is holding the finger in a flexed position. This technique works well for the short-term, but the contracture may return over time. Other advantages also include allowing the patient to return to work immediately afterward, and multiple joints and fingers can be worked on simultaneously. A disadvantage to needling is the possible damage to the other nerves and tendons, and the risk of increased pain.
In an attempt to break down the thickened tissue, the FDA has approved a collagen-based enzyme called Xiaflex. The enzyme is injected into the area, and over the next 24-72 hours, the enzyme softens the cord. Once the patient returns to the doctor, local anesthesia is used to numb the area, and then the doctor manipulates the finger gently to break the cord. By doing this, it will then allow the fingers to extend.
Disadvantages to this are comparable to needling, but also include the rare possibility of rupture of the tendon (during the manual manipulation) and possible allergic reactions to the enzyme.
If Dupuytren’s contracture is advanced or if the disease has been previously treated and recurred, our skilled hand surgeon can evaluate you for surgical release. Depending on the severity of the disease, the surgery will be tailored to your needs, which may include local vs total fasciectomy. Occasionally in the most severe conditions, the skin is removed and a skin graft is performed. These surgeries may require general anesthesia; for less-invasive cases, the surgeon may use local anesthesia, where the entire hand is numbed and the patient stays awake for the procedure. The hand is placed in a splint post-operatively.
Physical therapy is often a part of the recovery and is used to improve range of motion in the affected digits, as well as to help prevent recurrence.
Possible complications from surgery may include:
- Stiffness of the hand
- Decreased (or even loss) of sensation from nerve damage
Most patients heal well from the surgery, but it may not be a definitive cure. HIgh recurrence rates may be seen in patients with a family history, or in those who have contractures on other parts of the body. If you or someone you know may be suffering from Dupuytren’s, contact our plastic surgery office to find out how our skilled hand surgeon can improve your hand health, function and appearance.