What Causes Dupuytren’s Contracture?

Experts estimate that about 5% of the population in the United States has Dupuytren’s contracture, a condition that limits the mobility of your fingers. 

Researchers don’t fully understand why some people develop Dupuytren’s contracture and others don’t, but they do know what the condition sets in motion, leading to the deformity. 

The providers at Orthocenter are highly trained in hand surgery and follow new developments and treatments closely. If you can’t straighten your fingers, you may have Dupuytren’s contracture, and we may be able to offer treatments to help. 

The structure of your hand

Your hands are amazing. You can perform the most delicate tasks, yet exert surprising strength in your grip. Even the simplest things, like tying your shoes, require a fantastic level of dexterity that most of us rarely, if ever, think about. 

All of this mobility and strength is possible thanks to a complex and intricate combination of joints, ligaments, nerves, tendons, muscles, and soft tissue called fascia. If you consider the difference between the skin on the back of your hand and the skin on your palm, you can see the role of fascia. 

Fascia is a fibrous tissue that provides structure to the skin on your palm, holding it in place. It also protects the nerves, blood vessels, and other parts of your hand. Fascia and tendons are similar in that they are both connective soft tissues, but fascia isn’t connected to a specific muscle like tendons are. 

Dupuytren’s contracture 

When you have Dupuytren’s contracture, the fascia in your hand becomes thicker and tighter and separates into cords. You may also develop nodules or bumps along with the cords of fascia. The nodules may be tender at first. 

Over time, the cords can continue to thicken and shorten, pulling your fingers in toward your palms. The nodules are likely to get less tender, but larger. You may no longer be able to lay your hand flat. 

Dupuytren’s contracture limits your mobility, and may make it difficult to wear gloves, wash your hands, reach into your pocket, or perform other tasks. If your dominant hand contracts, you may find many activities more difficult. 

Most often the pinky and ring fingers are affected, but all fingers and your thumbs can be involved. 

For many people, Dupuytren’s contracture is not especially painful, though the nodules can be uncomfortable. Complications can occur, but for the most part, the deformity isn’t dangerous but is limiting. 

Treatments for Dupuytren’s contracture

Depending on how severely your hand is affected, along with your age, how quickly the disease is progressing, and other factors, several different treatments are available. Steroid injections may help reduce inflammation and potentially slow the progression of contracture. 

Historically, the most frequent and effective treatment for Dupuytren’s contracture has been surgical intervention. There are different types of surgery for Dupuytren’s contracture, though none actually cure the disease. It’s possible that you’ll develop cords again after having surgery. 

The two most common procedures are fasciotomy, where your surgeon divides the cords to decrease the contracture, and subtotal palmar fasciectomy, where your surgeon removes abnormal tissue and cords so that your fingers will straighten. 

Newer treatments are also available. An enzyme injection followed by manipulation to break apart the cords often improves your range of motion. This method usually involves faster healing and less pain than surgery, but the long-term results aren’t known. 

A procedure called needle aponeurotomy involves your doctor using a needle to break apart the contracted cords. Once the tissue is broken apart, the cords are lengthened, and you regain mobility in your fingers. 

Many different elements are important when it comes to the most appropriate treatment for your situation. The providers at Orthocenter carefully consider all of those elements prior to suggesting a course of treatment. 

If you’d like to learn more about Dupuytren’s contracture, schedule an appointment at one of our three convenient locations in Red Bank, Morganville, and Holmdel, New Jersey.