Tag: Dupuytren Contracture

Dupuytren’s contracture is a disease of the hand resulting in a deformity of the finger. It may have originated with the Vikings in Scandinavia and spread across Europe and then the world, as Viking influence spread. Whatever its origins, it can be a disabling and distressing condition.

If you have the symptoms or have had a diagnosis of Dupuytren’s contracture you may be wondering if it is curable. Read on to learn more about the condition and the answer to your question.

What is Dupuytren’s Contracture?

The condition, Dupuytren’s contracture, affects the fingers and hands. One, or sometimes more, fingers bend towards the palm of the hand. It can affect either or both hands and, in some cases, it can affect the thumb.

It usually starts when a nodule or hard lump forms under the skin of the hand. This small lump can be around a quarter of an inch in diameter. It can feel tender although this usually passes.

More nodules may develop. These nodules are benign (non-cancerous) and generally do not pose a problem at this stage. Over time the nodules can form an extended cord that runs along a finger or the thumb.

The cord can tighten or shorten bending the finger or thumb. The contraction pulls the finger or thumb towards the palm. Although this is generally painless it is progressive.

As the Dupuytren’s contracture gets worse the finger or thumb bends ever more towards the palm and into a permanently bent position. This can make using the hand difficult, especially when extending the hand. Playing a musical instrument, swimming or even shaking someone’s hand can be problematic.

What Are the Causes?

Other than the genetic background to Dupuytren’s contracture, we know little about the causes. It does often run in families. If you have the gene for Dupuytren’s contracture there are some factors that make it more likely.

It tends to affect older men, over 50 years of age. People with diabetes, epilepsy or who drink heavily or smoke have an increased chance of developing the condition. However, lots of people with the condition don’t have these problems.

Who Is at Risk?

The condition is quite common and although most cases are men over 50, women are also affected and there have been cases of children with the condition. It is more common in people with a northern European ancestry.

Because there is a genetic aspect to the disease it may not be preventable but avoiding some of the risk factors such as heavy drinking and smoking may reduce the risk.

Getting a Diagnosis

The key symptoms are:

• Nodules in the palm of the hand
• Lumps or pitted skin surface
• Thick skin
• Fingers bent towards the palm

If you have any of the symptoms described here, the first step is to have your hand examined by a physician. An examination will include a discussion with you about your symptoms and how they affect your life. Different people find that daily activities are more or less affected by the condition.

If the diagnosis is Dupuytren’s Contracture, the physician will assess the severity. In many mild cases, the physician will recommend no treatment until the severity gets worse. In other cases where the condition is more advanced, there is a range of possible treatments.

What Are the Treatments?

Following a diagnosis, your physician may suggest non-surgical treatment or a minor procedure called needle fasciotomy. Surgery is the recommendation in severe cases. Surgery options include open fasciotomy or fasciectomy.

Non-Surgical Treatment

Non-surgical treatments include radiation therapy or an injection of collagenase clostridium histolyticum.

Radiation Therapy

Radiation therapy may delay or prevent the advancement of the condition and so avoid surgery.

The treatment is believed to reduce the production of collagen and therefore the development of the cords. The treatment does not lead to a reduction of symptoms in all cases. There are also some minor side effects including dry and flaking skin.

Collagenase Clostridium Histolyticum

Xiaflex or collagenase clostridium histolyticum is an enzyme. An injection into the cords in the hand weakens the cord. Follow up treatment involves physically extending the range of movement of the finger.

Your physician will advise on the exact post injection procedures. It’s important to follow these precisely. Further injections may be administered.

Some side effects may be swelling, itching and some bruising and pain. Less common side effects include feelings of sickness or dizziness.

The benefits of collagenase clostridium histolyticum may be to increase movement of the fingers and delay or avoid the need for surgery.

Surgical Treatments

There are several surgical options your physician may consider.

Needle Fasciotomy

This procedure does not need an overnight hospital stay. A local anesthetic means the patient remains conscious throughout.

During the procedure, the surgeon inserts a needle or fine blade into the problem fibrous cord. This weakens the cord and reduces the tendency to pull the finger towards the palm.

The benefits of this procedure are:

• Less impact than major surgery
• Quick recovery
• Less risk of complications
• Improved use of fingers

The treatment has some effect but many people will experience a return of the contracture.

Open Fasciotomy

More serious cases need more invasive surgery. The aim is to have a long-term benefit but as with any surgery, there are risks, as well as potential benefits.

The operation can be under a local anesthetic and does not usually require admission to hospital. After the surgeon makes an incision in the hand, they cut the fibrous cord, weakening it. This allows straightening of the fingers.

The wound in the hand is then stitched and dressed. There will be some post-operative care required including removal of the stitches. The healing process takes longer than a needle fasciotomy and there will be some scaring.

Fasciectomy

This procedure is the most invasive of the options available. There are three types of fasciectomy.

During a regional fasciectomy the surgeon removes the affected tissue through a large incision. This is either using a local anesthetic which numbs the whole arm or alternatively under a general anesthetic. This means the patient is unconscious during the operation.

This type of surgery is the most common type used. It is a more invasive operation than an open fasciotomy and so it comes with a higher risk of complications.

A segmental fasciectomy is where the surgeon makes small cuts in the hand and removes small pieces of affected tissue. A dermofasciectomy is where the skin is also removed along with the affected fibrous cord. A skin graft, taken from another part of the body, covers the wound.

The effectiveness of fasciectomy is greater than other procedures with longer lasting results. There are lower rates of the Dupuytren’s Contracture returning than for non-surgical or other surgical procedures. A physician will discuss the risks of surgery with you prior to making a decision to operate.

Recovery

Recovery after treatment can take some time. After surgery, you may need physiotherapy to improve the range of movement. This can take the form of manipulation and exercises.

The fingers may be bandaged to a plastic strip for all or part of the day and night. This splinting may help the position of the fingers as well as the formation of scar tissue.

After recovery from surgery, there is a chance that the process that causes Dupuytren’s contracture will continue. This means that the condition could return.

A return of the condition is most likely with needle fasciotomy and least likely with fasciectomy.

Can Dupuytren’s Contracture Be Cured?

As Dupuytren’s contracture is probably caused by a genetic pre-condition there is no simple cure. The treatments described here have different degrees of success and for different time spans. This depends on the degree of advancement and severity of the condition.

All individuals have different experiences of how debilitating the condition is and how beneficial any improvement is. Different people respond to treatment differently and also vary in their recovery and experience of complications.

Research indicates that while there is no cure for Dupuytren’s disease it is possible to achieve a beneficial outcome following treatment. A reduction in inconvenient and uncomfortable symptoms is desirable for most people. Slowing down the progression of the condition is also very welcome.

What Should You Do If You Have Symptoms?

Dupuytren’s contracture can interfere with your ability to do everyday tasks such as driving, washing or dressing. It can impact work if it makes using a keyboard or tools difficult. It can have a social impact if it stops you shaking hands comfortably.

There may not be a complete cure but there is a range of treatments that you can discuss with a physician. Understanding your condition and getting a professional diagnosis is key.

To talk to someone about your symptoms, call or fill out our form.

Contact Us

Is Dupuytren’s contracture painful in some instances? Find out what can be done about it.

Have you ever noticed small, tender bumps in the fleshy part of your palms?

Those lumps could be a sign of Dupuytren’s contracture (DC), a condition in the hands that can result in limited functioning or your muscles. And, in some cases, can cause pain.

It’s important to learn everything you can about this condition to be able to prevent it and/or treat it. You may only have the beginning symptoms, but now is the most important time to understand what’s going on in your hands.

To learn how to treat your dupuytren contracture, keep reading.

What is Dupuytren’s Contracture?

Our hands have fibrous bands that stretch from your palm to the ends of your fingers. These bands are flexible and elastic when they’re healthy.

When someone has DC, those bands of tissue develop lumps that eventually cause the tissue to grow thicker. Those lumps can sometimes feel sore or tender, or not feel like anything at all. However, they are an indication of onset DC.

As the tissue becomes thicker, it contracts the bands that connect to your fingers causing them to curl inwards.

In severe cases, it causes hand deformity and loss of mobility in the hands.

What Causes It?

There hasn’t been a direct cause discovered for Dupuytren’s contracture yet. We do know that it isn’t caused by overuse of the hands or from an injury.

Research has shown that it is more common in men than women, especially men over the age of 50.

It’s also been proven to be hereditary; people of Northern Europe descent are more likely to have Dupuytren’s contracture.

As with many health conditions, the risk factors include smoking, alcohol consumption, and diabetes. It’s also been known to exist alongside other hand conditions like arthritis.

Symptoms

The first sign of DC is noticing 1-2 small lumps that develop in the palm of your hand. These lumps might be tender, or they may not be sensitive at all.

Your pinky and ring fingers are more commonly affected than your thumb, index, and middle fingers. You may notice some stiffness in these fingers.

It’s important you see a doctor as soon as you notice these lumps in your hands. Dupuytren’s contracture usually develops slowly over multiple years; monitoring it from the beginning will help doctors know what kind of treatment will work for you.

Is Dupuytren’s Contracture Painful?

There’s been some controversy over whether DC is a painful condition. For most patients, it is not painful. Your hands may feel stiff, tender, or uncomfortable.

In the minority of cases, there is pain present in the hands. The lumps can sometimes be very sensitive and sore. What we know from research is that if you experience pain at the onset of the condition, along with itchiness, that may be an indication that it is a more aggressive form of DC.

When to See a Doctor

You should see your family doctor as soon as you notice any lumps in your palms. They will likely do an exam on your hands to accurately diagnose the lumps and determine a solution.

The exam consists of your doctor checking the mobility of your hands, wrists, and fingers. They will feel the lumps and record how many. They may ask you to place your palm on the table to see if your hand can lay flat or ask you to pick up small items only using your thumb and a finger in a pinching motion.

These exams will need to happen regularly since this condition develops over many years.

Knowing your baseline exam records will help doctors see how fast the condition is developing; recording your symptoms can help dictate which method of treatment you use.

Treatment

Unfortunately, there is no cure for dupuytren contracture.

Even with the best treatments, there’s always a chance it could return. Luckily, it isn’t a life-threatening condition and many patients continue to lead full and happy lives with it.

There are a few different treatments available as well as preventative techniques. We’ll address each method in detail, so you can make a more informed decision, along with your doctor, on which one is right for you.

1. Preventative Measures

If you have a familial history of developing dupuytren contracture, it’s wise to go the extra mile with your hand health.

Stretching

Conservative stretching is a great way to maintain the flexibility in your hand’s fibrous bands. DC causes these bands to lose their elasticity, so stretching can help prolong or prevent the onset.

Start by gently bending the hand backward at the wrist to stretch out the bottom of your palm. Then, bend each finger backward to gently stretch the bands that connect the fingers to the palm. Bend the hand forward at the wrist to stretch the back of your hand.

Another beneficial stretch is to place your hand as flat as possible on a table, then lift up the palm while your fingertips remain on the surface. This feels wonderful on your finger tissues as well as your palm.

Massage

Whenever you notice soreness or stiffness in your hands, it can be soothing to give yourself a hand massage. Using anti-inflammatory creams, or lanolin ointment can reduce the tenderness.

Try using the thumb of your opposite hand to massage your palm and roll out any tension or stiffness. Massage the tendon upwards and downwards along the fingers.

In addition to stretching and massaging, avoid using a tight grip to lift anything unless it has cushion tape. Anytime you must do a task that requires gripping, consider using heavily padded gloves.

2. Medication

Your doctor might want to start treating your dupuytren contracture with medication since it’s less invasive than surgery. As mentioned above, there is no cure for DC, but these medications can greatly improve your condition.

Corticosteroid

One type of medication is a corticosteroid injection. This is an anti-inflammatory agent which will reduce the swelling and tenderness in your hands.

Although it does an excellent job of reducing any pain, it cannot reverse the contraction that has already occurred. However, it may prevent future contraction.

Collagenase

Another injection your doctor might choose is a collagenase injection. This medicine is made up of enzymes that dissolve the thickened tissue by weakening the tight bands.

Although it is a beneficial treatment, it can cause swelling, bleeding, and bruising in your hands.

With any type of injection, you may feel pain at the injection site. Some doctors will offer a topical anesthetic for patients who can’t tolerate pain from needles.

3. Traditional Dupuytren Contracture Surgery

If you’ve tried medicinal treatments and they didn’t improve your condition, it may be time to consider surgery.

The traditional, and most invasive, surgery for DC requires the surgeon to create an open incision and cut off the excess thick tissue in your palms. Patients can be put under anesthesia for this process.

As with any surgery, this one also comes with some risks: infection in the incision, damage to the nerves, and even potentially permanent finger stiffness. You should weigh the risks against the benefits to see if this treatment option is worth it to you.

Most patients fully recover after several months post-surgery and endure some swelling and stiffness after the procedure. Unfortunately, research has stated that the condition recurrence rate is 20% of people who have this surgery.

Physical therapy is usually required after surgery to help heal the hands and get them accustomed to broader functioning.

4. Aponeurotomy

This is another type of surgery that is less invasive than the traditional procedure, sometimes referred to as needling.

A specialized hand surgeon will use sharp needles to penetrate through the skin and cut loose the tight bands in your palms. There is no open incision, so the recovery process is faster than the traditional procedure.

Although it’s less invasive, it is also less effective when used to treat DC on its own. In conjunction with corticosteroid injections and self-massage, the outlook is much more successful.

5. Radiation

Another option for less invasive treatment is radiation therapy. Using low energy, the radiation can help reduce symptoms or halt them before they get worse. This often involves treating the lumps or nodules, and the bands in your hands.

Although this is an option for dupuytren contracture treatment, it hasn’t been studied nearly as much as the previous four options.

Interested in Learning More?

The hands are vulnerable to a variety of conditions besides dupuytren contracture.

Since your hands require the optimal functioning of so many different parts (muscles, nerves, bands, nails, etc.) it’s best to always be aware of any potential symptoms you may be experiencing.

Never be afraid to ask your doctor to look into what you’re experiencing, it could be the difference between having healthy hands and potentially losing function of them.

If you’d like to learn more about our services or have questions about possible treatment options, call us today!