Dupuytren’s disease or contracture is an abnormal thickening of the fascia, or soft tissue under the skin. It often begins with firm “lumps” in the palm. “Cords” can develop, extending from the palm towards the fingers, often the ring and small fingers. Ultimately, these might cause the fingers to contract or bend into the palm. Sometimes, nodules can be seen on the knuckles of the fingers or in the soles of the feet.
The cause of Dupuytren’s is unknown, but it is more frequently found in men over age 40 and those of northern European ancestry.
The initial nodules can be uncomfortable but not usually painful. Contracture of the fingers can cause problems with your daily activities. Unfortunately, there is no way to predict whether and to what extent your disease will progress, although earlier age of onset usually leads to more severe disease.
Patients without or with minimal contractures can be observed. As contractures occur and progress, however, surgery to improve finger position and function can be helpful. The major risks of surgery are recurrence of the contracture, nerve injury leading to loss of sensation, and wound problems. Hand therapy including splinting usually is included in the postoperative course.
An injectable substance to treat certain types of Dupuytren’s contractures is approved for use by the FDA. It is called Xiaflex. Not every contracture can be treated with this, and as with any procedure, there still are risks involved. Information can be found on the product website. If this is something that interests you, check with your insurer regarding whether this is an option and if so, schedule a consultation to see if you are a candidate and would like to pursue this.
Guillaume Dupuytren (1778-1835) described the contracture.