DUPUYTREN'S CONTRACTURE

Dupuytren's disease, an abnormal thickening of the fascia (the tissue just beneath the skin of the palm), often starts with firm lumps in the palm. In some patients, firm cords will develop beneath the skin, stretching from the palm into the fingers and gradually causing the fingers to bend into the palm.

Cause

The cause of Dupuytren's disease is unknown, but may be associated with certain biochemical factors within the involved fascia. The problem is more common in men over age 40 and in people of northern European descent. There is no proven evidence that hand injuries or specific occupational exposures lead to a higher risk of developing Dupuytren's disease.

Prevention

This condition becomes more common after the age of 40, and men are affected more often than women. Risk factors include alcoholism, epilepsy, pulmonary tuberculosis, diabetes and liver disease.

Treatment

Only observation is needed for nodules and cords that are not contracted. The presence of a lump in the palm does not mean that surgery is required or that the disease will progress.

Patients with more advanced contractures may require surgery to improve function. Various surgical techniques are available depending on the stage of the disease and the joints involved. The goal of surgery is to improve finger position and thereby hand function. Despite surgery, the disease may recur with the fingers bending into the palm again. Before surgery, the treating surgeon will discuss realistic goals and results.