Dupuytren’s contracture

Definition
Dupuytren’s contracture is a painless thickening and contracture of tissue beneath the skin on the palm of the hand and fingers. Progressive contracture may result in deformity and loss of function of the hand.

Causes, incidence, and risk factors

The cause of this contracture is unknown, but minor trauma and genetic predisposition may play a role. One or both hands may be affected. The ring finger is affected most often, followed by the little, middle, and index fingers.

A small, painless nodule develops in the connective tissue and eventually develops into a cord-like band. Extension of the fingers becomes difficult to impossible with advanced cases.

The condition becomes more common after the age of 40, and men are affected more often than women. Risk factors are alcoholism, epilepsy, pulmonary tuberculosis, diabetes, and liver disease.

Symptoms

• Painless nodule in the palm, developing into a cord-like band
  
• Thickening of the lines in the palms of the hands
  
• Extending the fingers is difficult—the 4th and 5th fingers curl up and are unable to be easily straightened (contracture)

A physical examination of the palm by touch (palpation) confirms the presence of thickened scar tissue (fibrosis) and contracture. Restriction of motion is common.

Treatment

Exercises, warm water baths, or splints may be helpful. The progression of the contracture is monitored.

Surgery may be performed to release the contracture, depending on the severity of the condition. Normal movement of the fingers is usually restored by surgery followed by physical therapy exercises for the hand.

Expectations (prognosis)

The disorder progresses at an unpredictable rate. Surgical treatment can usually restore normal movement to the fingers. The disease can recur following surgery in some cases.

Complications

• Deformity of the hand
  
• Loss of hand function due to contracture
  
• Risk of injury to blood vessels and nerves during surgery

Prevention
Awareness of risk factors may allow early detection and treatment.

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