Dupuytren’s contracture

Dupuytren’s contracture is a condition that causes one or more fingers to bend into the palm of the hand. Dupuytren’s contracture can affect both a patient’s hands, and is also known to affect the thumb on some occasions.

Dupuytren’s contracture is caused by the thickening of the connective tissue in the palm of the hand. Usually the connective tissue thickens in one particular area, causing a ‘nodule’ to form beneath the skin of the palm. Nodules are small hard lumps, usually about 0.5-1cm in size, which are non-cancerous (benign). Although nodules are not life threatening, they can sometimes feel tender, and can be irritating to live with.

If left over time, nodules will extend to form cords of tissue that run along the fingers and thumbs. As these cords contract (become shorter), they pull the fingers and or thumb, so that they become bent towards the palm. Although these contractures tend to be mild and painless, they can progressively worsen over time, and prevent you from straightening your fingers as much as you used to be able to.

In some cases no contracture will occur, and in these instances the condition is referred to as Dupuytren’s disease or palmar fibromatosis.

Symptoms

Duputren’s contracture affects everyone differently, however there are a number of initial symptoms that are usually experienced around the palm of your hand. Here are some of the most common signs:

  • Growth of small lumps of tissue (nodules)
  • Thickening of skin
  • Tenderness
  • Unusual dimples or pitted marks developing
  • Bent fingers or thumbs

Dupuytren’s contracture will usually affect the fingers, however in some instances it can also affect the thumbs too. The ring and little fingers tend to be the most commonly affected, followed by the middle finger. In very rare cases, Dupuytren’s contracture has also been known to affect the toes and soles of the feet.

Dupuyutren’s contracture can take place in one or both the hands. In cases where only one hand is affected, contracture will usually develop in the right hand, regardless of whether you’re left or right handed.

As the condition worsens, fingers can eventually end up becoming permanently bent, making it difficult to perform many normal daily activities.

If you are unable to fully extend your fingers, or you think that you may be experiencing any of the other above symptoms, you should contact your GP who can refer you to Mr Bhatia.

Causes

The exact cause of Dupuyten’s contracture is still unknown, however research shows that the condition is often genetic and can run in your family.

Dupuytren’s contracture is a fairly common condition that affects both men and women, although men tend to experience it more than women do. The condition usually occurs during later life, usually in men over 50 and women over 60. In some very rare instances, Dupuytren’s contracture has also been witnessed in children.

If you are thought to have a gene that causes Dupuytren’s contracture, other conditions such as diabetes, and lifestyle factors such as smoking may contribute to its onset. Certain medications, such as the medication for epilepsy, can also help to activate the condition, although it is not known how significant any of these factors are.

For those that are at risk of developing Dupuytren’s contracture – if you have had it in the past or you have a family history of it – quitting smoking can help to reduce your risk.

Treatment

A lot or cases of Dupuyten’s contracture will not require treatment, however in any case where the condition is affecting the normal functioning of your hand and therefore interfering with daily activities, treatment is recommended.

In order to determine the severity of the condition, the amount of deformity (how much your fingers or thumbs are curling into the palm of your hand) is assessed.

In cases where only a small amount of deformity has occurred, often no treatment is recommended as there is a strong likelihood that the condition will not get any worse. If however the condition is more severe, Mr Bhatia will either prescribe medication or recommend you undergo a minor procedure called a needle fadciotomy, where a needle is used to cut the contracted cord of tissue. This procedure is most effective in the early stages of the condition, and can be performed under local anaesthetic as a day case procedure.

In the most severe cases, Mr Bhatia will recommend you undergo surgery to correct the problem and help restore hand function.

Surgery for Dupuytren’s contracture

Dupuytren’s contracture cannot always be fully corrected by surgery, and contracture can recur after surgery.

Undergoing surgery to remove the first nodule that appears will not guarantee stopping the condition from progressing to other areas in the palm, therefore it is often best to avoid any surgery until the contracture has become too much of a burden. The two surgical techniques utilised by Mr Bhatia are:

Open Fasciotomy

An open fasciotomy is a surgical procedure that is performed to treat the more severe cases of Dupuytren’s contracture. The procedure is a more extensive operation than a needle fasciotomy, however like a needle fasciotomy, an open fasciotomy can be carried out under local anaesthetic as an outpatient procedure.

The surgery involves Mr Bhatia making an incision in the skin of the hand to gain access to the thickened connective tissue underneath, which he then cuts to divide it up, allowing the fingers to straighten.

Fasciectomy

There are three variations of a fasciectomy procedure:

  • Partial fasciectomy – the most common surgery for Dupuytren’s contracture that involves removing only the affected connective tissue
  • Segmental fasciectomy – removing small segments of connective tissue through small cuts made to the skin
  • Dermofasciectomy – If the disease has affected the overlying skin, the connective tissue and the overlying skin are removed, and the wound is sealed with a skin graft.

A fasciectomy is usually performed under general anaesthetic, however in some cases a regional anaesthetic, where local anaesthetic is injected into the nerves of your neck to numb the arm, will be utilised.

A fasciectomy is a more invasive procedure than a fasciotomy, and therefore the results tend to be longer lasting.

Recovery

Following hand surgery, the patient’s hand will be sealed with stitches and a dressing is applied.

A follow up appointment to remove the stiches will be required within 14 days of the procedure.

Throughout Mr Bhatia’s Bristol clinics, onsite hand therapists will be available to help oversee the after care, and advise on exercises and techniques to ensure a full and speedy recovery.