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What Are the Causes of Dupuytren's Contracture?

Reviewed on 6/3/2020

What Is Dupuytren’s Contracture?

Dupuytren's Contracture
The cause of Dupuytren’s contracture is unknown. It can limit the extension of the affected finger.

Dupuytren's contracture (also called Dupuytren disease) is a condition that results in gradual and progressive thickening and shorting of tissue under the skin on the palm (the palmar fascia) and can affect how the fingers move. It can involve one or both hands, and usually affects the fourth and fifth fingers (the ring finger and little finger/pinky).

What Are Symptoms of Dupuytren’s Contracture?

Symptoms of Dupuytren's contracture may affect one or both hands and include:

  • Thickening of the tissue under the skin of the palm (usually painless)
  • Decreased range of motion in the hand 
  • Loss of dexterity 
  • Stiffness of finger joints
  • Hard bumps (nodules) under the skin of the palm
  • Bands of tissue under the skin of the palm
  • Difficulty straightening fingers all the way (usually the ring and little fingers)
  • Getting a hand stuck when trying to put it in a pocket

What Causes Dupuytren’s Contracture?

The cause of Dupuytren’s contracture is unknown but risk factors for developing the condition include:

Gender: Males are three times more likely to develop the condition and it is more severe in males

How Is Dupuytren’s Contracture Diagnosed?

There is no specific test for Dupuytren’s contracture. The condition is usually diagnosed through a medical history and physical exam. 

Because diabetes mellitus is often associated with Dupuytren’s contracture, a fasting blood glucose level may be indicated if diabetes mellitus is suspected. 

Ultrasonography may detect thickening of tissue under the skin on the palm (the palmar fascia) and the presence of nodules. 

What Is the Treatment for Dupuytren’s Contracture?

Treatment for Dupuytren’s contracture depends on the severity of the condition. If not treated, Dupuytren’s contracture can become disabling.

Treatment for Dupuytren’s contracture may include:

  • Physical and occupational therapy
    • Stretching with the application of heat and ultrasonographic waves 
    • Wearing a custom splint or brace to stretch the fingers 
    • Range of motion (ROM) exercises 
  • Collagenase injection to help weaken and dissolve the Dupuytren cord
  • Fasciectomy – removal of the fascia
    • Surgical removal
    • Via percutaneous needle (a needle is used to break apart the thick tissue)
  • Corticosteroid injection with triamcinolone acetonide (Kenalog-40
  • Radiotherapy to slow disease progression 
  • Medications
    • Tumor necrosis factor (TNF) inhibitors - adalimumab (Humira) injection is currently being studied as a treatment to reduce nodule size and hardness

What Are Complications of Dupuytren’s Contracture?

Without any treatment or physical therapy, Dupuytren’s contracture will progress in about half of all patients over six years of follow-up. Fibrous bands can form and radiate outward causing the fingers to become contracted by the taut cords, impairing hand function.

What Is the Staging for Dupuytren’s Contracture?

Dupuytren’s contracture occurs in three stages:

Proliferative phase – In this early phase, patients may experience tenderness and discomfort associated with the hard lumps (nodules). When fingers are extended, the skin of the palms turns white.  
  • Involutional phase - In this phase the nodules thicken into cords and the skin begins to shrink. 
  • Residual phase – In this later phase, the condition keeps spreading into the fingers and the cord tightens creating a shortening of muscle tissue (contracture). 

 

How to Prevent Dupuytren’s Contracture

Avoiding certain risk factors for Dupuytren’s contracture may prevent the condition or delay the onset in people who are predisposed. Risk factors that can be controlled include:

  • Avoid hand trauma
  • Avoid manual labor with vibration exposure
  • Do not drink alcohol or drink in moderation
  • Don’t smoke
  • Keep diabetes under control
  • Keep levels of fats in the blood under control 

Stretching exercises and massage may help prevent the condition from progressing. 

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Reviewed on 6/3/2020
References
Source: http://emedicine.medscape.com/article/329414-overview

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