Dupuytren's Contracture: Symptoms, Causes, and Treatment

What is Dupuytren's Contracture?

Dupuytren's contracture is a progressive connective tissue disorder in the palm that causes thickening and shortening of the palmar fascia (the connective tissue beneath the skin of the palm). As a result, the fingers – most commonly the pinky and ring fingers – bend toward the palm and are difficult to fully straighten. This condition can significantly affect hand functionality and hinder the performance of daily activities.

Dupuytren's contracture typically progresses slowly over months or years and is often painless, but it can severely limit finger movement. It is more common in men than women, particularly in middle-aged or older individuals. While the condition is not life-threatening, it can greatly impact quality of life by limiting the ability to use the hands for everyday tasks such as writing, typing, or even shaking hands.

Symptoms of Dupuytren's Contracture

Dupuytren's contracture begins with mild symptoms that become more pronounced over time. Symptoms to watch for include the following:

• Thickening of the skin on the palm: The first sign of Dupuytren's contracture is usually a thickening of the skin on the palm, often near the base of the fingers. The skin may feel harder or swollen, and small lumps, known as nodules, may appear. The skin in the affected area can become wrinkled and firm, causing discomfort when using the hand, even in the early stages.
• Nodules under the skin: As the condition progresses, small, firm nodules develop under the skin, which can be felt to the touch. These nodules may be slightly painful, especially in the early stages, but typically become painless as the disease advances. The nodules can enlarge and form cords of connective tissue that pull the fingers toward the palm.
• Bending of the fingers: One of the most common symptoms is the bending of the fingers toward the palm, making it difficult to fully extend them. The most frequently affected fingers are the pinky and ring fingers, but the condition can develop in other fingers as well. This finger bending makes simple tasks like shaking hands, holding a cup, or typing on a keyboard more challenging.
• Limited hand mobility: Over time, the thickened fascia and finger bending can cause limitations in hand mobility, making daily activities such as gripping objects, writing, and shaking hands difficult. Mobility limitations can also lead to changes in muscle strength, as the hand becomes less functional. This can result in reduced independence and the need for assistance with daily tasks.

Dupuytren's contracture typically develops slowly, and symptoms are often overlooked in the early stages. However, as the condition progresses, it can significantly impact quality of life. Therefore, it is important to seek medical attention as soon as you notice the first signs.

Causes of Dupuytren's Contracture

The exact cause of Dupuytren's contracture is not fully understood, but certain factors increase the risk of developing this condition. The causes and risk factors can be summarized as follows:

• Genetics: Dupuytren's contracture often runs in families, indicating a significant genetic component. If one of your parents or grandparents had this condition, you are more likely to develop it. Genetic predisposition plays a crucial role in the development of the disease, meaning the risk is higher if there is a family history of this condition.
• Age: Dupuytren's contracture most commonly develops in people over the age of 50. The older you are, the greater the risk of developing the condition. This is likely due to changes in connective tissue with age, making it more prone to thickening and shortening.
• Gender: Men are more likely to develop Dupuytren's contracture than women. The condition often occurs in a more severe form in men, requiring more aggressive treatment. Additionally, men tend to experience this condition earlier than women, necessitating earlier intervention.
• Other risk factors: Other risk factors include smoking, alcohol consumption, and certain health conditions such as diabetes, epilepsy, or liver disease. Smoking and alcohol affect blood circulation and the quality of connective tissue, which can accelerate the progression of the condition. Diabetes increases the risk of Dupuytren's contracture due to metabolic changes and its impact on the tissue that causes fascial thickening.

It is important to note that Dupuytren's contracture can develop without obvious causes or known risk factors. While heredity is a major factor, the condition can also occur in individuals without a family history. Treatment is therefore tailored to each individual to achieve the best possible outcomes.

Treatment Options for Dupuytren's Contracture

Treatment for Dupuytren's contracture depends on the severity of the symptoms and their impact on the individual's daily life. Treatment options include:

• Observation and monitoring: In the early stages, when symptoms are mild and do not cause limitations, observation may be recommended. A physiotherapist or doctor can monitor the progression of the disease and assess whether active treatment is necessary. Regular check-ups are important to track disease progression and take timely action to prevent further deterioration.
• Physiotherapy and stretching exercises: Physiotherapy can help maintain finger mobility and reduce the risk of contracture progression. Physiotherapists use various techniques such as stretching exercises, massages, and splinting to improve mobility and prevent the shortening of the palmar fascia. Exercises are tailored to the individual's specific needs to preserve maximum hand functionality. Regular physiotherapy can also reduce discomfort and prevent the condition from worsening rapidly.
• Collagenase injections: Collagenase is an enzyme injected into the nodule to break down the collagen fibers causing fascia shortening. This procedure can alleviate symptoms and allow easier finger extension without surgery. Injection treatment is minimally invasive and has a short recovery time but is not suitable for all patients, especially those with advanced disease.
• Needle fasciotomy: This procedure involves using a fine needle to break apart the thickened tissue under the skin, releasing the fingers. It is a minimally invasive procedure that allows immediate improvement in mobility, but there is a chance of recurrence. Needle fasciotomy is less aggressive than traditional surgery but requires precision to avoid damaging surrounding tissue.
• Surgery (fasciectomy): In advanced cases where other methods fail, surgery may be the only option. During the surgery, the surgeon removes the thickened tissue, allowing the fingers to straighten again. Post-surgery physiotherapy is usually needed to restore hand mobility and strength. Surgery is effective but requires a longer recovery and carries risks such as infection or scarring.

With the right approach and early treatment, it is possible to preserve hand functionality and improve quality of life, allowing for better management of this chronic condition.