Dupuytren’s Contracture

A Guide to Symptoms, Causes, and Treatment

Dupuytren’s Contracture: A Guide to Symptoms, Causes, and Treatment

Introduction: What is Dupuytren’s Contracture?

Have you noticed lumps or cords developing in your palm? Perhaps even fingers starting to pull involuntarily towards your hand? These could point to Dupuytren’s disease (Dupuytren’s contracture) – a hand condition that, fortunately, has various treatment options. Understanding its causes, potential progression, and knowing when to seek help is crucial for taking back comfortable hand function.

Baron Dupuytren

Baron Dupuytren

Dupuytren’s Disease: A Brief History

Dupuytren’s disease has a surprisingly long and somewhat controversial history. Evidence points to possible descriptions of hand contractures by Viking explorers as early as the 9th century! Later, famed Swiss surgeon Felix Platter documented, in detail, a case in 1614.

However, it’s Baron Guillaume Dupuytren, a prominent French surgeon, who gained his place in medical history. His landmark lecture in 1831 drew wide attention to the condition, detailing its key features and proposing invasive surgical solutions – thus, solidifying the name “Dupuytren’s contracture”. Notably, he wasn’t the first to describe the disease, leading to discussions regarding the accuracy of naming it after him. An Englishman, Sir Astley Cooper described it well before the Baron!

Nevertheless, Dupuytren’s work sparked vital interest in researching this puzzling condition, leading to gradual strides in its understanding and, most importantly, the development of treatments aimed at improving patients’ lives.

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Recognising Dupuytren’s Disease: The Signs and Symptoms

Dupuytren’s often creeps up gradually. Here’s what to look for:

The Nodule: An Early Clue

The first sign typically involves a small lump (nodule) within your palm, commonly appearing towards the base of your ring or little finger. It can feel tough, almost like a tiny pebble under your skin. While usually painless, some experience initial tenderness.

Puckered Skin and Cords: The Condition Progresses

Over time, the nodule may thicken and extend, leading to a rope-like band (cord) beneath your skin. The skin nearby can draw inward (pucker), reminiscent of dimpling. It’s these cords that pull fingers towards the palm, limiting normal straightening.

Contracture: When Grip and Function are Affected

One or more fingers might become noticeably bent inwards (contracture), impacting everything from a firm handshake to opening a jar. Tasks involving precision grip might become increasingly tricky.

A Few Important Notes

  • Mostly Painless (however, early tenderness is possible)
  • Both Hands: Often affected but can show up with differing severity between hands.
  • Unpredictable Course: While generally slow-progressing, the speed and extent of symptoms vary tremendously. Some cases stay mild, while others become more severe.

What Causes Dupuytren’s Contracture?

While the root cause remains a bit of a medical puzzle, here’s what we know:

Fascia Changes:

Fascia is a flexible but sturdy connective tissue layer found all throughout your body. In Dupuytren’s, the normally supple fascia of the palm thickens and tightens. It’s the layer under the palmar skin that stops the skin moving when you grip something. Imagine gripping something and the skin moving! That’s why you don’t have the fascia on the back of your hand…you don’t need it!

Genetics Play a Role:

Dupuytren’s often runs in families, pointing to a strong genetic predisposition.

Other Associated Factors:

  • Northern European descent (more common)
  • Gender (affects men more frequently)
  • Age (more likely to be diagnosed after age 40)
  • Certain health conditions: Links have been observed (though less commonly) with diabetes, epilepsy, and high alcohol consumption.
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Treatment options for Dupuytren’s Disease:

  • Segmental Fasciectomy: The most common approach for me when the cords are in the palm and are not causing too much contraction. The cords are surgically removed, aimed at allowing greater finger extension. I do these under local anaesthetic as a “minor op” in a treatment room.
  • Partial Fasciectomy: If the disease is more extensive, then I need a tourniquet and that means having a regional anaesthetic and main theatres.
  • Dermofasciectomy: Less frequently performed, it combines fascia removal with skin excision and grafting, used in complex cases. Has a lower recurrence but higher complication rate.

After Dupuytren’s Surgery: The Road to Recovery

Surgery aims to release contracted fingers, but the healing journey continues well after leaving the operating room. Understanding the phases ahead helps set realistic expectations and get the best result.
Immediate Post-Op: First Steps of Healing
Splinting & Support: Your hand will be bandaged and may very occasionally be splinted to protect the surgical site and facilitate healing.
Pain Management: Medication prescribed by me will help manage any discomfort.
Elevation: Swelling is normal – elevate your hand as directed to minimise swelling.

The Early Weeks: Therapy Begins

Follow-up Visits: Expect an appointment at <1 week with the hand therapists and a wound check with me at 2 weeks.
Hand Therapy Starts <1 week: A vital part of your recovery journey! Specialised therapists address:
Wound and Swelling Management: May include techniques to encourage healthy circulation and wound care instructions.
Gradual, Guided Exercises: Initial focus on restoring basic range of motion, reducing any scar tissue stiffness, and promoting flexibility.
Pain Control: Therapists offer strategies to manage discomfort during exercise sessions.

Mid-Recovery: Gaining Function

Progressing Your Program: As healing continues, your hand therapist will tailor exercises to fit your individual needs. This may include:
Strengthening: Rebuilding grip power and fine motor coordination.
Increased Range of Motion: Activities progressively focus on restoring lost joint movement.
Scar Management: Gentle massage techniques to soften any raised areas around the incision.

Timeline Considerations

Gradual, Consistent Improvement: Most see gains each week with therapy. Don’t get discouraged by a seemingly slow pace – focus on the progress.
Job Demands: Return to light duties might be possible in a few weeks, while work involving heavy grasping or prolonged wrist use could take several months
Long-term Benefits: Continued at-home exercise programs may be advised, even after formal therapy has finished to maximize outcomes.

Important Reminders

Everyone Heals Differently: Some recover faster than others. Factors like surgical method, your overall health, and commitment to therapy all play a role.
Addressing Discomfort: While mild pain is common during activity in the early weeks, communicate any sharp or constant pain with me or your therapist.
Risk of Recurrence: Be aware that contractures could slightly recur for some over time. Follow-up with me and consistent hand exercises can help.
The Mental Factor: Healing isn’t purely physical – having patience with yourself during a possibly longer-than-expected recovery is important. Seek support if needed.

Why Choose Me for Your Dupuytren’s Contracture Treatment?

As a consultant hand surgeon, I’ve dedicated my career to helping people regain the use of their hands and improve their quality of life. My philosophy centres around achieving the best possible outcome for each patient with the least amount of disruption to their daily activities. When it comes to Dupuytren’s contracture, this means carefully weighing the benefits and drawbacks of each treatment option to tailor a plan that suits your individual needs and lifestyle.

The decision between more invasive procedures (like dermofasciectomy) and less invasive ones (like local anaesthetic partial fasciectomy) is complex and highly personal. While dermofasciectomy may offer a lower risk of recurrence, it often requires more downtime for recovery. On the other hand, less invasive options may get you back to your work and hobbies sooner, but with a higher chance of the contracture returning over time.

I’ll work closely with you to understand your priorities and concerns. Together, we’ll develop a treatment strategy that strikes the right balance between effectiveness, recovery time, and long-term outcomes. My goal is to help you regain the full use of your hand, so you can get back to doing the things you love with minimal disruption.

When to Consult a Doctor

Spotting Changes: Noticeable lumps, dimpling skin, or thickening in your palm or fingers warrants visiting me.
Functional Interference:  When finger motion becomes impaired and impacts your daily life, work or more importantly the joy in life that you experience, come and see me.

Disclaimer

The information provided in this blog is intended for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for diagnosis, treatment recommendations, and any questions related to a medical condition. The author, contributors, and publisher of this blog shall not be liable for any direct or indirect losses or damages related to the use of the information presented herein.

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Meet Ali Phillips, Your Orthopaedic Hand and Trauma Surgeon

Ali Phillips is a fellowship-trained hand surgeon dedicated to educating and empowering his patients. He believes in clear information and shared decision-making. When not in the clinic, you might find him wing foiling or on a cycling adventure. Connect: alistairphillips.co.uk @ali.thehandsurgeon on IG, Twitter/X, Threads, FB and TikTok. Find out more: About page