Expert Health Articles

Dupuytren’s Contracture of the Palm

Dupuytren's contracture is a benign disorder of collagen, which is in the body's connective tissue. It is named after the French surgeon, who performed the first surgery for the condition. The disorder causes progressive fibrosis (fibrous thickening) of the superficial palmar fascia in the hand. The layer of tissue between the skin and flexor tendons of the hand, in line with the finger, start to thicken to form a hard ball, called a nodule. Sometimes the nodule is painful, and sometimes it isn't.

That nodule can continue to progress lengthwise into a thick band of scar-like tissue called a cord. This process puckers and tethers the skin but spares the flexor tendon of the finger. The cord starts to draw the finger down into a bent position towards the palm, causing a thickening or contracture, rendering the patient unable to straighten their finger. This can severely limit daily activities and occupations. It can even prevent a person from being able to put their hand in their pocket! The small, ring and middle fingers are usually the fingers affected by the disorder.

The cause is unknown, but it is a genetic (inherited) disorder associated with Northern European ancestry. White males over 50 years old are more likely to have the disease, but it can affect all races and genders. There have been some studies to link repetitive tasks and vibratory work as well as diabetes, alcohol use and smoking to the disease. Nodules from this disease can also appear on the soles of the feet and on the penis. For some, the symptoms progress slowly over time, and for others, the symptoms progress more rapidly.

There isn't a cure for the disorder, but there are treatments. Because there isn't a cure, all treatments have a risk of recurrence. Treatment for the mild presentation of symptoms is mild passive stretching, wearing a glove during repetitive gripping tasks, and watchful waiting. As a patient develops cords or flexion contractures, other options for treatment, including injections and surgery, can be an option. A collagen dissolving (protein collagenase) enzyme administered by injection is a non-surgical treatment offered in the office used to lyse or break the cord eliminating the flexion contracture and restoring motion of the finger.

The enzyme attaches to the collagen cord and breaks it down, making it vulnerable to breaking. This involves an injection of the cord, followed by manual extension manipulation three days later by the provider to break the cord, which restores the finger's motion. Specially trained providers can only do these injections. The most common side effects of the injections are tenderness and skin sensitivity at the injection site, bruising, swelling and itching. Other side effects that are very unlikely include skin tear, tendon rupture, infection and allergic reaction.

The surgical treatment for Dupuytren's contracture of the palm would be an outpatient procedure to perform a limited palm cord excision and debride or remove the nodules/cord(s). Both injection and surgical treatments have a period of recovery involving splinting and home exercise programs. With surgical intervention, a patient must heal an incision.

Patients with Dupuytren's carry a higher risk for infection and wound complications, nerve and/or vessel damage and loss of range of motion. Both treatment options provide a good likelihood of success and symptom relief for patients suffering from this disorder. Contact your local orthopedic specialist, preferably one who has been trained in collagenase injections and surgery for Dupuytren's disease of the palm for guidance on the best treatment options.

 

Katie Fultz, PA-C and James Davidson, MD

Orthopaedic Surgery

Blanchard Valley Orthopedics & Sports Medicine