Dupuytren's Contracture - Part I

What is it

Dupuytren’s contracture is a contracture of the palmar fascia or connective tissue that lies below the skin of the palm. The palmar fascia normally forms a fan-like layer between the skin and the tendons in the palm of the hand and extends into the fingers. It is designed to immobilize the skin on the palm to aid the grip. [1] This contracture causes the fingers to bend towards the palm, making it difficult to straighten. The fascia thickens and shortens, causing the fingers to bend towards the palm, not being able to move freely, making it difficult to straighten. [2]

In patients with this condition, scar tissue accumulates under the skin on the palm of the hand. [2]

The little and ring fingers are most commonly affected but all the fingers can become involved. Often the skin over the knuckle of the middle joint of the fingers forms thickened nodules called Garrod’s knuckle pads. [1]

Causes

The cause for Dupuytren’s contracture is still unknown, but has a slight tendency to run in the family and it is known that it occurs more frequently in patients with diabetes, epilepsy and alcoholism. It is also more common in men that in women. It usually begins at 50-60 years of age, but it may occur in younger people, particularly when it runs in the family. [1]

When it appears at an early age, it usually progresses rapidly and is often very severe. The condition tends to progress more quickly in men that in woman. [3]

People who smoke have a greater risk. Heavy smokers who abuse alcohol are even more at risk. Recently it was found a connection with people suffering from diabetes. It hasn’t been determined if work tasks is a cause of risk, or can speed the progression of the disease. [3]   ´

Symptoms

Normally, Dupuytren’s contracture progresses slowly and is usually painless. It may initially present as only a minor lump or nodule in the palm of the hand near the base of the fingers. As Dupuytren’s Contracture develops, dimpling and puckering of the skin over the area may be seen and the thickened tissue will give rise to firm cord-like bands extending into the ring or little fingers. The affected fingers start to bend more and more and eventually can become difficulty straightened. [2]

The condition commonly first shows up as a thick nodule (knob) or a short cord in the palm of the hand, just below the ring finger. More nodules forms, and the tissues thicken and shorten until the finger cannot be fully straightened. Dupuytren’s contracture usually affects only he ring and little finger. The contracture spreads to the joint of the finger, which can become permanently immobilized. [2]

People lose the control of flexing their fingers and grab objects as the disorder develops and the palmar fascia contracts and tightens. This contracture is like a little scar just under the skin. As the disorder progresses, the bending of the finger becomes more and more severe, which limits the motion of the finger. [3]

Without treatment, the contracture can become so severe that you cannot straighten your finger, and eventually you may not be able to use your hand effectively. At times, the nodules can be very painful. [3]

[1] Fact Sheet: Dupuytren’s contracture. Wesley Hand Centre

[2] Dupuytren’s Contracture. RSIA: Repetitive Strain Injury Association

[3] Dupuytren’s Contracture. Physiotherapy in Leeds for Hand