Dupuytren Contracture

What is Dupuytren Contracture

Dupuytren contracture is a condition in which tissue under the skin of the palm becomes abnormally thickened. This causes one or more of the fingers to curl inward (contract) toward the palm.

Eventually, the fingers may not be able to straighten out. This condition affects some or all of the fingers and the palm of the hand. It is often passed along from parent to child (inherited).

Dupuytren contracture is a long-term (chronic) condition that develops (progresses) slowly over time. There is no cure, but symptoms can be managed and progression can be slowed with treatment. This condition is usually not dangerous or painful, but it can interfere with everyday tasks.

What are the causes?

This condition is caused by tissue (fascia) in the palm getting thicker and tighter. When the fascia thickens, it pulls on the cords of tissue (tendons) that control finger movement. This causes the fingers to contract.

The cause of fascia thickening is not known.

What increases the risk?

This condition may be more likely to develop in:

  • People who are age 40 or older.
  • Men.
  • People with a family history of this condition.
  • People who use tobacco products, including cigarettes, chewing tobacco, and e-cigarettes.
  • People who drink alcohol excessively.
  • People with diabetes.
  • People with autoimmune diseases, such as HIV.
  • People with seizure disorders.

What are the signs or symptoms?

Symptoms may develop in one or both hands. Any of the fingers can contract. The fingers farthest from the thumb are commonly affected. Usually, this condition is painless. You may have discomfort when holding or grabbing objects.

Early symptoms of this condition may include:

  • Thick, puckered skin on the hand.
  • One or more lumps (nodules) on the palm. Nodules may be tender when they first appear, but they are generally painless.

Symptoms of this condition develop slowly over months or years. Later symptoms of this condition may include:

  • Thick cords of tissue in the palm.
  • Fingers curled up toward the palm.
  • Inability to straighten the fingers into their normal position.

How is this diagnosed?

This condition is diagnosed with a physical exam, which may include:

  • Looking at your hands and feeling your hands. This is to check for thickened fascia and nodules.
  • Measuring finger motion.
  • Doing the Hueston Tabletop Test. You may be asked to try to put your hand on a surface, with your palm down and your fingers straight out.

How is this treated?

There is no cure for this condition, but treatment can make symptoms more manageable and relieve discomfort. Treatment options may include:

  • Physical therapy. This can strengthen your hand and increase flexibility.
  • Occupational therapy. This can help you with everyday tasks that may be more difficult because of your condition.
  • A hand splint.
  • Shots (injections). Substances may be injected into your hand, such as:
    • Medicines that help to decrease swelling (corticosteroids).
    • Proteins (collagenase) to weaken thick tissue. After a collagenase injection, your health care provider may stretch your fingers.
  • Needle aponeurotomy. In this procedure, a needle is pushed through the skin and into the fascia. Moving the needle against the fascia can weaken or break up the thick tissue.
  • Surgery. This may be needed if your condition causes discomfort or interferes with everyday activities. Physical therapy is usually needed after surgery.

In some cases, symptoms never develop to the point of needing major treatment, and caring for yourself at home can be enough to manage your condition. Symptoms often return after treatment.

Follow these instructions at home:

If you have a splint:

  • Do notput pressure on any part of the splint until it is fully hardened. This may take several hours.
  • Wear the splint as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the splint if your fingers tingle, become numb, or turn cold and blue.
  • Do notlet your splint get wet if it is not waterproof.
    • If your splint is not waterproof, cover it with a watertight covering when you take a bath or a shower.
    • Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
  • Keep the splint clean.
  • Ask your health care provider when it is safe to drive.

Hand Care

  • Take these actions to help protect your hand from possible injury:
    • Use tools that have padded grips.
    • Wear protective gloves while you work with your hands.
    • Avoid repetitive hand movements.
  • Avoid actions that cause pain or discomfort.
  • Stretch your hand by gently pulling your fingers backward toward your wrist. Do this as often as is comfortable. Stop if this causes pain.
  • Gently massage your hand as often as is comfortable.
  • If directed, apply heat to the affected area as often as told by your health care provider. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
    • Place a towel between your skin and the heat source.
    • Leave the heat on for 20–30 minutes.
    • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Manage any other conditions that you have, such as diabetes.
  • If physical therapy was prescribed, do exercises as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You develop new symptoms, or your symptoms get worse.
  • You have pain that gets worse or does not get better with medicine.
  • You have difficulty or discomfort with everyday tasks.
  • You have problems with your splint.
  • You develop numbness or tingling.

Get help right away if:

  • You have severe pain.
  • Your fingers change color or become unusually cold.

Dupuytren Contracture Surgery

Dupuytren contracture surgery is a procedure to break up or remove thick tissue (fascia) in the hand. Dupuytren contracture is a hand condition in which fascia becomes thickened. This causes certain fingers to curve inward (contract) toward the palm. The goal of surgery is to return the affected fingers to their normal positions and improve hand function.

This procedure does not cure Dupuytren contracture, but it may be necessary when the condition causes discomfort or interferes with everyday tasks.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.
  • Previous hand injuries you have had.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines.
  • Damage to other structures or organs, such as connective tissue (tendons) or nerves in the hand. This could cause numbness or weakness in the hand.
  • Scarring of the hand.
  • Return of Dupuytren contracture. Surgery may relieve symptoms temporarily, but they often return.

What happens before the procedure?

  • You may have a physical exam of your hand.
  • You may have a blood or urine sample taken.
  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
  • Follow instructions from your health care provider about eating or drinking restrictions.
  • Ask your health care provider how your surgical site will be marked or identified.
  • You may be given antibiotic medicine to help prevent infection.
  • Plan to have someone take you home after the procedure.
  • If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
  • An IV tube will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb your hand (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
  • One or more incisions will be made in your hand.
  • Thick fascia will be broken up or removed. Your surgeon will test your finger movement and try to straighten your fingers.
  • In some cases, skin on the hand may also be removed. If this is needed, skin from another place on your body (graft) will be removed and placed over your incision. Usually, a skin graft comes from the wrist or forearm.
  • The incision will be closed with stitches (sutures). Skin glue or adhesive strips may also be used to close your incision.
  • A bandage (dressing) will be put over the incision. This may include a splint to keep the fingers in place so they do not move.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • You may continue to receive medicines and fluids through an IV tube.
  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
  • You will have some pain. Medicine will be available to help you.
  • You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
  • Do notdrive for 24 hours if you received a sedative.
  • Ask your health care provider when it is safe to drive if you have a splint on your hand.

Care After Dupuytren’s Contracture Surgery

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

  • Pain, swelling, and stiffness in your hand, especially near your incision.
  • Some clear fluid or blood leaking from your incision.

Follow these instructions at home:

If you have a splint:

  • Do notput pressure on any part of the splint until it is fully hardened. This may take several hours.
  • Wear the splint as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the splint if your fingers tingle, become numb, or turn cold and blue.
  • Do notlet your splint get wet if it is not waterproof.
  • Keep the splint clean.

Bathing

  • Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
  • If your splint is not waterproof, cover it with a watertight covering when you take a bath or a shower.
  • Keep your bandage (dressing) dry until your health care provider says it can be removed.

Incision care

  • Keep your incision area clean and dry.
  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
  • Check your incision area every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Warmth.
    • Pus or a bad smell.

Managing pain, stiffness, and swelling

  • If directed, put ice on the affected area.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Move your fingers often to avoid stiffness and to lessen swelling.
  • Raise (elevate) your hand above the level of your heart while you are sitting or lying down.

Driving

  • Do notdrive or operate heavy machinery while taking prescription pain medicine.
  • Do notdrive for 24 hours if you received a sedative.
  • Ask your health care provider when it is safe to drive if you have a splint on your hand.

Activity

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Rest and protect your hand until it feels better.
  • Stretch and massage your hand as told by your health care provider.
  • If physical therapy was prescribed, do exercises as told by your health care provider.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you were prescribed an antibiotic medicine, take it as told by your health care provider.Do not stop taking the antibiotic even if you start to feel better.
  • Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You develop new symptoms, or your symptoms get worse.
  • You have pain that gets worse or does not get better with medicine.
  • You develop numbness or tingling in your hand.
  • You have more redness, swelling, or pain around your incision.
  • You have more fluid or blood coming from your incision.
  • Your incision feels warm to the touch.
  • You have pus or a bad smell coming from your incision.
  • You have a fever.
  • You have problems with your splint.

Get help right away if:

  • You have severe pain.
  • Your fingers change color or become unusually cold.
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