Under the skin of the palm is the palmar fascia. It makes your skin rigid and connects the skin to the bones of the hand so that you can forcefully grasp objects without tearing your skin.It’s located beneath the skin in the palm and fingers, and when it starts thickening and tightening it may be hard not to notice. This tightening is a condition called Dupuytren’s contracture and in some of its most severe cases, it may make even the simplest of daily tasks difficult (like shaking hands or grasping objects).

So, what causes Dupuytren’s contracture? What are the risk factors, and what are your treatment options? Read more to find out!

What are Dupuytren’s contracture symptoms? 

There are a lot of different symptoms of Dupuytren’s contracture, but the big ones are:

• Lumps in the palm (usually between the ring finger and palm), called a nodule
• Development of thick bands of tissue from the palm to the fingers, called cords
• Finger flexion deformity (can’t straighten your finger)
• Skin puckering, called a pitting.
• Knuckle pads, called Garrod’s Nodules
• Hand discomfort (in some cases, it may even cause pain and even itchiness)
• Visible deformity that makes it challenging to grab things and lay your hand flat on a table top.

Besides just causing discomfort, this serious quality-of-life problem can be frustrating. This makes this hand condition one of the more sensitive problems a patient can have. 

What causes Dupuytren’s contracture? 

It’s still not fully understood what exactly causes Dupuytren’s contracture. However, most experts agree that it’s a multifactorial condition with genetic and environmental factors playing a part. Some of the factors that are known to facilitate this disease are:

• Genetic predispositions: If you have Dupuytren’s contracture in your family, you’re in a risk group.
• Age: Older people are more likely to develop it. This is one of the most significant risk factors since it’s pretty rare to see it in someone younger than 40.
• Sex: Men are more likely to develop Dupuytren’s contracture than women.
• Ancestry: Dupuytren’s contracture is more common among Northern Europeans, which is why one of the names of this illness is also Viking disease.
• Smoking and alcohol consumption: These bad habits increase the risk of developing Dupuytren’s contracture.
• Diabetes: While the link between these two diseases is still unclear, people with diabetes have an increased risk of developing Dupuytren’s contracture.
• Trauma: If you have hand surgery or have a broken finger this may cause Dupuytren’s to present or speed up the contracture.

In the US, there’s an estimate that just between 3% and 6% of people have Dupuytren's in some capacity, but if you’re in the risk group, these numbers can go drastically up. For instance, in some areas of Norway, about 40% of men older than 60 have some form of this disease. In other words, you should take these risk factors seriously.

What does the early stage of Dupuytren’s contracture look like?  

The key thing in treating this disease lies in early detection and diagnosis. This disease usually starts with small nodules or lumps. They’re often completely painless, which makes many people ignore them.

Then, you’ll start feeling mild discomfort or tenderness in the palm (usually in the area around the nodules). Sometimes you will feel a slight resistance and pulling sensation when you try to stretch your fingers.

Finally, the flexibility of the hand will start diminishing. This starts with limited finger extension, especially in the ring and little fingers.

What are Dupuytren’s contracture treatment options?

Over the past few years, there have been many trials for new drugs and breakthroughs in treating Dupuytren’s contracture. These range from injecting the anti-TNF drugs to reduce nodule hardness/size to different trials on the subject. Still, there are also a lot of traditional (both surgical and non-surgical) treatments for this disease.

Non-surgical treatment for Dupuytren’s contracture? 

There are many non-surgical treatment options for Dupuytren’s contracture.

• Needle aponeurotomy: A hand surgeon uses a needle to puncture and break the thickened cords. It’s considered non-surgical because it doesn’t involve incisions, and there’s no tissue removal.

• Percutaneous needle fasciotomy: This procedure is similar to needle aponeurotomy because it uses a needle to separate fibrous cords, which gives the finger greater extension.
• Collagenase injection: A collagenase enzyme is injected directly into the Dupuytren’s cord. This enzyme breaks down the contracted tissue and gives you greater finger extension.

These methods are usually reserved for treating Dupuytren’s contracture with a contracture. It is easiest to do these procedures in its early stages. They can be performed under local anesthesia and are minimally invasive, and the recovery time is much shorter than any surgical procedure.

What is Dupuytren’s contracture surgery like? 

The main procedure is called fasciectomy and involves removing the thickened tissue. Now, there are many different types of fasciectomy. There are also:

• Partial
• Limited
• Complete

These are based on the portion of the cord that is getting removed. However, there’s also a categorization based on the affected area. There, you have fields like:

• Dermofasciectomy: Where the skin is also removed.
• Limited palmar fasciectomy: Only the cords and tissue causing the tissue are removed.
• Regional fasciectomy: Only the tissue from the limited region is removed when the contracture is localized.
• Subtotal palmar fasciectomy: A thin fascia layer is left behind while most of Dupuytren’s tissue is removed.

The type of surgery is determined by your level of contracture and surgeon preference..

Wrap up

In the end, Dupuytren’s contracture is treatable. The sooner you start, the better. Remember that your hands are probably the part of your body you use the most and a part you never put much thought into until your mobility gets limited. Then, it becomes a major concern. You shouldn’t let it come to this, especially with so many options on your plate.

To learn more, you should find a Dupuytren’s contracture expert at the Orthopedic Institute of New Jersey.