Dupuytren's contracture is a shortening and thickening ofthe palm's tissue that results in clawing of the fingers.
The cause is unknown, but it is thought to have a
hereditary component. Other risk factors include advancing age and certain conditions, such as alcoholism, epilepsy and diabetes. Treatment includes a range of
therapies or surgery.
The palm of the hand contains a deep layer of tissue called the palmar fascia, which extends across the palm to the fingers. Dupuytren's contracture is a thickening and shortening of this web of fascia that gradually causes clawing of the fingers as they are pulled towards the palm. The ring and little finger are usually targeted, but any finger can be affected.
The disease tends to progress in fits and starts, and may take decades to finally limit the functioning of the hand. The exact cause is unknown, but the incidence of Dupuytren's contracture is higher among certain groups including:
People with diabetes.
People with epilepsy who are treated with
phenytoins (epilepsy medication).
People who abuse alcohol.
Dupuytren's contracture can sometimes run in families, which suggests a genetic susceptibility. Treatment depends on the severity of the condition, but may include injections of corticosteroids into the palm and surgery.
Symptoms of Dupuytren's contracture
The features include:
A lump or nodule appears on the palm, usually
close to the base of the ring or little finger.
There is the appearance of a thickened cord
running along the palm to the fingers.
Over time, as the contracture develops, the
fingers become clawed as they are pulled towards
The hand bows.
The fingers are completely pulled against the
Often, the skin of the palm is dimpled and
There is rarely any associated pain.
The cause of Dupuytren's contracture
The exact trigger that causes the palmar fascia to thicken and contract is unknown. However, contributing factors may include:
Age the condition is more common in middle
to later years of life.
Gender up to 10 times more males than
females are affected.
Heredity the condition tends to run in families.
Ancestry those with Celtic or Scandinavian
ancestry are at increased risk.
Certain medical conditions - people with
diabetes and epilepsy have a higher incidence of
Alcoholism the contracture tends to be
common, and comparatively more severe, in
In most cases, only the hands are affected.
Other associated difficulties can include:
Garrod's pads the finger joints on the same
hand may enlarge and thicken.
Ledderhose disease creates thickening and
shortening of the foots deep connective tissue.
As the disease progresses, it can cause quite
severe pain while walking.
Peyronie's disease there may be
thickening and shortening of tissue in the penis.
Treatment options for Dupuytren's contracture
Treatment depends on the severity of the condition. In its earlier stages, treatment may include injections of corticosteroids into the fascia. These medications reduce any localised tenderness and may help to delay subsequent thickening of the tissue.
More recent treatments showing promise include therapy with calcium channel blockers, treatment with gamma-interferon and percutaneous needle fasciotomy.
In severe or advanced cases, the person is unable to lay their hand palm-down on a flat surface, or their fingers have contracted into their palm so that the hand is no longer functional. Surgery is then the best option.
Dupuytren's contracture can sometimes return after surgery, either at the same site or elsewhere on the palm. Usually, the contracture progresses at the same speed as previously.
Depending on the severity of the condition, the surgery options may include:
Cutting the fascia bands through small incisions
in the palm .
Removing the thickened fascia.
Removing the fascia and associated skin, and
using a skin graft to seal the palm.
Amputation of an affected finger, if the
contracture has returned so many times that
corrective surgery is no longer possible.
Occupational therapy is needed after surgery to speed recovery and reduce the risks of the contracture returning. Techniques may include:
Splints worn at night for a few months to
straighten the finger.
Sometimes, a splint worn during the day.
Special hand exercises to encourage flexibility.
Gentle massage with moisturising hand cream.