Dupuytren’s contracture is a condition in which the palmar fascia (the tough fibrous tissue just beneath the skin) contracts and tethers the skin, producing dimples, lumps, and cords in the palm of the hand and fingers. Occasionally this is seen on the soles of the feet, a condition known as Ledderhose’s Disease. The condition is benign (i.e. not a tumor) but the tissues can cause such severe contraction of the skin that the joints of the hand become curled and unable to straighten. Patients may notice difficulty placing the hand flat on a table, shaking hands, or sliding the hand into a glove or a pants pocket.
It is unknown why some people develop Dupuytren’s contracture and some do not. However, it most often occurs in middle-aged and older males, usually of Northern European descent. Once Dupuytren’s contracture occurs, it does not spontaneously resolve and the contractures are permanent unless treated by a hand surgeon.
Example: Dupuytren’s Contracture
Dupuytren’s Contracture Treatment
This is a surgical procedure where the finger is straightened and the cords and nodules in the palm are removed. Usually this is followed by some hand therapy. Patients usually have excellent results and the rate of recurrence (fingers curling again in the future) is the lowest of all treatment options. The primary disadvantage of this treatment is that it involves surgery. Visual details of this surgery can be seen here (warning: graphic content).
This is a minimally invasive procedure done in the office, in which an enzyme is injected into the cord in the palm of the hand. Over the next 48 hours, the enzyme dissolves a portion of the cord. The patient returns the day after the injection or even the day after that, and under local anesthesia the surgeon forcibly manipulates the fingers into a straightened position, rupturing the cord. This is an attractive option because it is least invasive and offers the fastest recovery with no scarring. However, the rate of recurrence is higher than for surgical fasciectomy. This procedure is also much less effective when multiple fingers are involved or multiple joints are contracted, or when the proximal interphalangeal joint (“small knuckle”) is involved. Also, the cord is ruptured but not removed so patient still have a significant mass in the palm of the hand. Finally, at the present time for most patients, this option carries the highest out-of-pocket expense.
This involves numbing the hand and then using a large needle to repeatedly puncture the hand until the “cords” rupture, allowing the hand and fingers to straighten. The advantages of this treatment are that it does not leave scars on the hand and may be considered “minimally invasive”. The disadvantages are that only a few surgeons offer this form of treatment, and the rate of recurrence is the highest of all of the treatment options. Furthermore, the cord is simply broken up, but it remains in the hand and is not removed.
Last but not least, “watchful waiting” is a perfectly acceptable and harmless treatment option as long as the contractures are not interfering with the patient’s ability to use the hand or getting worse. To help decide which treatment is right for you, please make an appointment with one of our hand surgeons.