What is Dupuytren's Contracture?
What is Dupuytren's Contracture?
Dupuytren's contracture otherwise known as Dupuytren’s disease is a common condition that affects around 2 million people in the UK.
It's a condition that's six times more common in men than women and it tends to occur in people who are over the age of 50. People living in Scotland, Iceland and Norway have the highest incidence of Dupuytren’s.
Dupuytren’s is a condition that creates a thickening in the connective tissue underneath the skin of the palm. The tissues of the palm become thickened and scar like. Whilst it's not always painful, it does restrict movement, pulling on the tendons of the fingers causing them to curl inwards to the palm.
Picking up large objects with your hand is made very awkward by Dupuytren’s, and many patients tell me that they struggle putting their hand in their pocket, or if they're washing their face, they may poke themselves accidentally in the eye.
The ring finger is the finger most affected, but not usually the index finger or thumb.
What causes Dupuytren's?
We don't really understand why Dupuytren’s occurs, but there may be a genetic component to it. If we look under the microscope at tissue affected by Dupuytren’s, we can see that there is an excess of myofibroblasts which lay down an excessive amount of connective tissue called type three collagen.
This results in the thickening and tightening of the fascial tissue. It's also thought that smoking, excessive use of alcohol and conditions such as diabetes or high cholesterol may have a part to play as well.
In the early stages, the skin on the palm of the hand may begin to feel a little bit thicker, and there may be bumps or nodules present. It’s important to say that if it’s not bothering you, it’s not necessary to treat it.
If, however, you're finding that your finger is beginning to be pulled in toward your palm, it may be time to consider treatment.
When you come to clinic, I’ll ask you lot of questions about how your hand is behaving, and how it is affecting your day-to-day life. I’ll examine your hand and I’ll be looking for thickening of the palm tissues, and range of movement of the figures. Patients with Dupuytren’s will be unable to fully flatten the palm of their hand onto a flat surface, such as a table top.
What can be done to treat Dupuytren’s Contacture?
Various treatments have been trialled for Dupuytren’s contracture, such as corticosteroid injections and even radiation therapy, but these haven’t been shown to be very effective.
If your finger is flexed to more than 30 degrees at the metacarpophalangeal joint (the joint where the finger meets the palm) or the deformity affects the finger joints, then probably surgery is the right move.
The surgery is a day-case procedure involving a light general anaesthetic and it takes about an hour and half.
An incision (which runs in a ‘zig-zag’ shape) is made in the palm and the thickened tissue is removed allowing the fingers to regain their proper movement.
When you wake up, you'll find your hand is in a firm bandage or a cast and you’ll need to keep the hand elevated in a sling for a couple of weeks. At two weeks, the stitches will be removed, your bandage or cast will be changed to a splint, and you’ll begin therapy with a hand therapist.
Can Dupuytren’s come back?
Even after surgery, there is a risk that Dupuytren’s can recur, and this can happen in 70-80% of patients in the 10 years after the surgery.
We know from large studies that surgery for Dupuytren’s is both safe and effective.
As with all surgical procedures, there are potential risks such as infection, damage to blood vessels and nerves, but thankfully these are rare.
After the surgery it’s natural to experience some pain of discomfort, but this can readily be treated with painkillers. Your ability to use your hand will be limited for a month or so, and will returning to work may take a few weeks, depending on the nature of your job.
If you’re concerned about Dupuytren’s and would like to discuss whether surgery is right for you, please get in touch