| Many people find that as they age it becomes increasingly difficult to
fully extend or stretch their fingers. In many cases, arthritis or some other joint
disease may be to blame. But a condition in the palm of the hand may also cause the
fingers to contract. Dupuytren’s (pronounced du-pwe-trahns’) contracture is a
fairly common condition that occurs when the connective tissue (fascia) under the skin
begins to thicken and shorten. As the tissue tightens, it may pull the fingers down
towards the palm of the hand. In some individuals, the condition may progress until the
involved fingers become disabled.
Who is at risk for Dupuytren’s contracture
- People of northern European descent. There is a genetic component to Dupuytren’s
contracture.
- Men. The incidence of Dupuytren’s contracture is about seven times higher among men
than among women.
- People of middle age. Most of the time, Dupuytren’s contracture doesn’t show
up until after age 40. However, a very aggressive form may appear in teenagers and
children.
- Diabetics, alcoholics and people taking anticonvulsant drugs for epilepsy.
Signs and symptoms of Dupuytren’s contracture
The first sign is a thickening (nodule) in the palm of the hand that most frequently
develops near the base of the ring or little finger. The nodule, which can resemble a
callus, is painless but may be tender to the touch. Gradually, other nodules may develop
and extend a contracture across the first joint into the finger. The overlying skin begins
to pucker, and rough cords of tissue extend into the finger. As the process continues,
these cords tighten and pull the finger in toward the palm. The ring finger is usually
affected first, followed by the little, long and index fingers. The problem is not pain,
but the restriction of motion and the deformity it causes.
The progress of the disease is often sporadic and unpredictable. Exactly what triggers
the formation of nodules and cords is unknown. As the disease progresses, the diseased
tissue wraps itself around and between normal tissue.
Many people do not seek medical care until the contracture is well advanced. The only
treatment for this condition is surgery, which is usually reserved for individuals who
have developed deformity as a result of the progressive contracture. Because many nodules
do not progress to contracture and because scar tissue from previous surgeries can make
excision of recurrent nodules more difficult, surgical removal of isolated nodules is not
indicated in most cases. |
|
A good guideline for determining when to consider surgery is the "table top
test." Try to place the palm of your hand completely flat on a hard surface. If you
can’t, the contracture has progressed to a point where surgical intervention could be
helpful.
Surgical Treatment for Dupuytren’s contracture
Several different surgical techniques can be used to remove the thickened fascia and
correct the contracture. Your surgeon will select a technique based on his or her
experience, training, and approach. The aim of the surgery is to release the contracture
and improve hand function by removing the diseased tissue.
The results of surgery are usually good, and the fingers can return to normal extension
after therapy. However, the disease can return even some years after the initial surgery.
Dupuytren’s contracture usually does not recur beneath a skin graft, so this may be
an option in especially aggressive forms of the disease.
After Surgery
It’s important to follow your doctor’s orders regarding therapy and treatment
after surgery. You will probably have to wear a splint so that the fingers stay extended.
The splint is usually worn full time immediately after the surgery and then only at night
for several months. You will also have to do some active range-of-motion exercises so that
the finger retains mobility and strength. |
