Dupuytren's Contracture

Plymouth Orthopaedic and Sports Injury Clinic

Other names: Dupuytren’s disease, Vikings disease

What is it?

A contracture in the hand preventing the finger(s) fully straightening.

Symptoms

The condition is usually painless. It frequently begins with the development of firm nodules or lumps in the palm. Ultimately cords of thickened tissue may develop, leading into the fingers and causing them to curl over. Patients can make a fist but are unable to fully straighten the fingers. This may happen over months or years. The affected fingers may catch on objects or get in the way, particularly when washing the face or putting on gloves

What causes it?

The exact cause is unknown. It tends to run in families. Patients with diabetes, liver disease or hand trauma have a higher risk of developing Dupuytren’s contracture but many people acquire the condition with no known risk factors.
It is found commonly in Northern Europe and is believed to have been brought to this country by the Vikings.
Despite the fact that the condition spreads in the hands and often recurs after removal, it is not a cancer and does not harm patients’ general health

Treatment

Observation – not all cases require treatment. Intervention is usually recommended when joint contractures reach 20 - 30 degrees. In some patients, lumps never progress to contractures.

Needle fasciotomy – a needle passed through the skin under local anaesthetic may be used to divide the cords causing the contracture. Patients usually resume full activities within a day or two. However the contracture may return over the next 2 – 3 years in more than half of patients treated.

Enzyme injection – in appropriate cases, an injection of collagenase may be used to break down the contracture. The injection is given on one day, and the patient returns the next day to have the finger straightened under local anaesthetic. The hand usually returns to function within a few days. As this technique is relatively new, the chance of the contracture returning is not yet established, but studies have suggested 20-40% recurrence at 3 years.

Surgery – under a general anaesthetic as a day case, the diseased tissue can be removed from the hand or finger. The hand often takes several weeks to recover. The chance of recurrence of the contracture is lowest after surgery.

No procedure is guaranteed to stop the disease coming back and the finger(s) may not be fully straightened after any of the treatments. Your surgeon will discuss the pros and cons of the various treatment options with you.