Dupuytren's Syndrome (Hand Contracture)

Dupuytren's Syndrome is a condition that affects the palmar fascia, the connective tissue that lies beneath the skin in the palm of the hand. The condition causes contractures, or tightening, of this tissue in the hand. Because of the contractures, the fingers can become permanently bent down and the function of the hand is impaired. The palmer fascia is a thick tissue that lies above the tendons and below the skin of the hand. The fascia is attached both to the skin above and to structures below. The palmer fascia helps provide a tough, gripping surface for the hand and fingers.

WHAT CAUSES DUPUYTREN'S SYNDROME?

No one really knows what causes Dupuytren's Syndrome, but it is well known that it runs in families -- 60% to 70% of individuals have a family history of the condition. Other factors have been suspected for causing Dupuytren's contracture, such as trauma, diabetes, alcoholism, epilepsy, and liver disease, but there is no clear relationship. The condition is most common in older (usually after age 40), men (more common than women), with North European ancestry (one group commonly cited is those with Viking ancestry).
There is evidence that trauma may contribute to development of Dupuytren's Syndrome. It has been investigated if specific traumatic events or a history of manual labor may contribute to this problem. Microscopically, there is evidence of bleeding within the affected tissues, evidence that trauma may contribute to this condition. That said, Dupuytren's is often seen in both hands, and found just as often in dominant and non-dominant hands -- evidence that this problem is not the result of repetitive trauma.

FORTELLING FACTORS FOR DUPUYTREN'S SYNDROME

1. Heredity: A history of this condition within your family is an indication that it will be more aggressive.
2. Sex: Dupuytren's usually begins later, and progresses more slowly in women.
3. Alcoholism or Epilepsy: These conditions are associated with Dupuytren's that is more aggressive, and more likely to recur.
4. Location of Disease: When in both hands, or when there is associated foot involvement, the progression tends to be more rapid.
5. Behavior of Disease: More aggressive Dupuytren's is more likely to recur after surgery and continue to be aggressive.

WHAT SHOULD I EXPECT IF I HAVE DUPUYTREN'S SYNDROME?

The first clinical signs of Dupuytren's Syndrome are usually small, painless nodules in the palm. The nodules may begin to coalesce and the skin becomes puckered. Eventually, in the later stages of disease, the skin and underlying fascia contracts, causing an impairment of hand and finger function. People with Dupuytren's contracture have fingers that are bent down towards their palm.

While all fingers can become involved, Dupuytren's contracture most commonly affects the ring and little fingers. The progression of Dupuytren's tends to be in rapid bursts, followed by periods of little change. Dupuytren's contracture is seldom painful, but can be a great nuisance. Dupuytren's is usually limited to involvement of the hand, but can also involve other parts of the body, most commonly the soles of the feet. About 5% of patients with Dupuytren's contracture also have a similar condition of the soles of the feet called Lederhose's Disease.

WHAT ARE THE TREATMENT OPTIONS FOR DUPUYTREN'S SYNDROME?

For many years, treatment in the early stages of Dupuytren's Syndrome was a watch and wait situation. There is no known way to alter the course of Dupuytren's Syndrome, thus many surgeons recommended to simply monitor the problem. Patients were usually seen every several months or years to have the extent of the condition regularly monitored.

Recently, less-invasive treatment options have given some hope that Dupuytren's Syndrome can be well managed, especially if treated in the earlier stages of the problem. We do know that the worse the contracture, the harder it will be to ever have normal hand function again. Therefore, many people are looking for less-invasive treatment options, especially for early Dupuytren's Syndrome.

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WHAT IS THE REHABILITATION FOR TREATMENT OF DUPUYTREN'S SYNDROME?

Rehabilitation is relatively quick. Usually patients can resume normal activities immediately, and are instructed to refrain from sports and heavy labor for about a week. Depending on the type of contracture, a removable splint may be given to be worn a few hours each day.

Rehabilitation after surgery varies significantly. Patients with minimal contractures may be able to resume normal activities one the incisions heal, within a few weeks. More severe contractures may require months of splinting and rehabilitation with a hand therapist to prevent scar tissue formation.

SOURCE

Thank you to about.com for providing some of the information on this page. About.com is website created by a medical review board that closely reviews information for medical accuracy and consistency with source material. The source of this material was the Journal of the American Academy of Orthopaedic Surgeons.