Dupuytren's Contracture-Causes, Symptoms and Treatments

Reviewed By doctors of Asia Medical Specialists

(Last updated on: July 7th  2021) 

What is Duputren’s contracture

Dupuytren's contracture (also known as Viking disease, Celtic hand, Morbus dupuytren) is deformity condition that the fingers (in most cases, the little or ring finger[1]) bent in a flexion position permanently.  This condition is a disorder of the connective tissue.  The condition is a result of thickening and shortening of the connective tissues in the hand, including the fascia (fat and bands of fibrous tissue); the skin are also involved[2].

Dupuytren's contracture symptoms

The development over Dupuytren's contracture can be slow over years and can occur in both hands while the ring finger and little finger are most commonly affected.

Early signs of Dupuytren’s contracture[3]:

• Thickening of the skin on the palm
• Forming of small, hard nodules just under the skin of the palm
• Skin on palm puckered or dimpled
• Nodule feel tender but not painful

Later stage of Dupuytren’s contracture

• Cords of tissues form under the skin shortened and tightened, starting to impair the finger function.
• As the cords tighten, they pull the fingers in toward the palm and show difficulty to straighten out the fingers
• Difficult to place the palm flat on the surface or opening the hand fully.
• Sensation of pain, itching and aching developed with the contractions.
• Decrease the person’s ability to hold large objects and make simple movements like washing face or putting on gloves

Grading over Dupuytren's contracture disease

GRADE 1	GRADE 2	GRADE 3
Thickened nodule and a band in palmer that have skin tethering, puckering or pitting	A visible rope like cord that limits the extension of the finger	Finger bended towards the palm

Dupuytren's contracture causes

Though dupuytren's contracture has been reported as early as in the 1600s, at this stage, the actual causes of Dupuytren's contracture is yet to be known.  Currently there is no solid evidence that hand injuries or occupations that involve vibration to the hands cause the condition.  However there are some risk factors that may increase the risk of the disease.

• Age: Statistically, Dupuytren's contracture occurs most commonly after the age of 50
• Gender: Male are more likely to develop this disease and to have more severe condition than women
• Ancestry: A person with a heritage of Northern European Decent are at higher risk of the disease. For ethnic groups such as Chinese and Africans, Dupuytrens is unusual.
• Family history: it was found that usually Dupuytren's contracture runs in the families
• Tobacco and alcohol use: Smoking and alcoholism are also associated with Dupuytren's contracture
• Chronic illness: Diabetes person are also reported to have an increased risk of the condition

Dupuytren's contracture diagnosis

• Look and feel: comparing the hands to each other and check for pits and grooves on the skin of the palms
• Table top test: placing the hand flat on a table palm down to see if it lies flat. (IMAGE required)
• Grip Test: To test how well you can grasp an object with your hands (Usually not affect)
• X-rays sometimes are ordered to examine if the deformity is due to other contributing, bony abnormalities

Other Diagnosis

Dupuytren's contracture diseases can also be confused with other diseases of the hand such as stenosing flexor tenosynovitis (trigger finger), ganglion cysts, and soft tissue masses.

Dupuytren's contracture treatment

Depends on the severity, doctors would might even not recommend any treatment as the condition may not worsen.  Recommendation of treatments follows the followings:

• Injecting the lumps with corticosteroid to ease the inflammation. 
• Injection enzymes into the palm to weaken the bands and doctor will move the hands until the bands are broken and fingers can be straightened. Currently this is not available in hk
• Minor surgical procedure: This would be recommended if there is a impaired functionality or severe contracture. There are two common options:
  1. Needle fasciotomy : a procedure performed under local aneasthetic.
  2. Open regional fasciectomy: performed under general anaesthetic under outpatient procedure. 

Dupuytren's contracture treatment – Needle fasciotomy

• A sharp blade or very fine needle is inserted into the fibrous bands of your palm or fingers
• Divide the thickened connective tissue and release the tightness in your hand

Dupuytren's contracture treatment –Open regional fasciectomy

This treatment is usually performed when the condition of the contracture are more severe. Comparing to fasciotomy, theoretically, it is more effective in long run, however the risk may be relatively higher.

1. An incision is made in your hand at the location of the affected connective tissue
2. The connective tissue that are affected will be removed. The degree of the connective tissues have to be removed depends on the condition.
   1. Short segments of the cord are removed through one or more small incision is called segmental fasciectomy.
   2. Regional fasciectomy means the entire cord is removed through a single longer incision and
   3. Dermo fasciectomy mans the entire cord and overlying skin is removed.
3. Skin graft may be used to seal your wound. (For dermo fasciectomy)

[1] "Dupuytren contracture". Genetics Home Reference. US: National Library of Health, National Institutes of Health. (last accessed June 21,2021)

[2] "Dupuytren contracture". Genetics Home Reference. US: National Library of Health, National Institutes of Health. (last accessed June 21,2021)

[3] Walthall J, Rehman UH. Dupuytrens Contracture. InStatPearls [Internet] 2019 Feb 19. StatPearls Publishing.Available from:https://www.ncbi.nlm.nih.gov/books/NBK526074/ (last accessed June 21,2021)