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Dupuytren Contracture

(Dupuytren's Contracture; Palmar Fibromatosis)

By David R. Steinberg, MD, Associate Professor, Department of Orthopaedic Surgery, and Director, Hand and Upper Extremity Fellowship, Perelman School of Medicine at the University of Pennsylvania

Dupuytren contracture is a progressive tightening of the bands of fibrous tissue (called fascia) inside the palms, causing a curling in of the fingers that eventually can result in a clawlike hand.

  • Dupuytren contracture develops in people who are genetically predisposed.

  • Typical symptoms include formation of a nodule in the palm and, eventually, curling in of the fingers.

  • Doctors base the diagnosis on an examination of the hand.

  • Treatment may involve injection of a corticosteroid into a tender nodule or, if the hand is already scarred, injection of collagenase into a nodule or surgery to correct contracted (clawed) fingers.

Dupuytren contracture is a common hereditary disorder that occurs particularly in men, especially after age 45. However, having the abnormal gene does not guarantee that someone will have the disorder. About 5% of people in the United States have Dupuytren contracture. The disorder affects both hands in 50% of people. When only one hand is affected, the right hand is affected twice as often as the left.

Dupuytren contracture is more common among people with diabetes, alcoholism, or epilepsy. The disorder is occasionally associated with other disorders, including thickening of fibrous tissue above the knuckles (Garrod pads), shrinking of fascia inside the penis that leads to deviated and painful erections (penile fibromatosis [Peyronie disease]), and, rarely, nodules on the soles of the feet (plantar fibromatosis). However, the specific factors that cause the fascia of the palm to thicken and curl in are unknown.

Symptoms

The first symptom of Dupuytren contracture is usually a tender nodule in the palm (most often at the ring or small finger). The nodule may initially cause discomfort but gradually becomes painless. Gradually, the fingers begin to curl. Eventually, the curling worsens, and the hand can become arched (clawlike).

Diagnosis

  • A doctor's examination

The doctor makes the diagnosis of Dupuytren contracture by examining the hand.

Treatment

  • Injection of a corticosteroid

  • Injection of collagenase

  • Surgery

An injection of a corticosteroid into the nodule may help decrease the tenderness in the area if it is done before the fingers begin to curl. However, the tenderness often resolves without treatment. The injection does not delay the progression of the disorder.

For mild to moderate scarring, one or more injections of collagenase (an enzyme that can break down scar tissue) may help restore the ability to move.

Surgery is usually needed when the hand cannot be placed flat on a table, when the fingers curl so much that hand function is limited, or when multiple fingers are involved. Surgery to remove the diseased fascia is difficult because the fascia surrounds nerves, blood vessels, and tendons. Dupuytren contracture may return after surgery if removal of the fascia is incomplete or newly diseased fascia have developed, especially in people who developed the disorder at a young age or have family members affected by the disorder or in people who have Garrod pads, Peyronie disease, or nodules on the soles of the feet.

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  • SANTYL