June 2, 2022 | Dupuytren’s contracture is a hand deformity that usually develops over the years. The condition affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin, eventually creating a thick cord that can pull one or more fingers into a bent position. Named after a famous French surgeon who was the first to operate on the deformity in the early 19^th century, Dupuytren’s contracture occurs in about five percent of people in the United States. The condition is three to 10 times more common in people of European descent than in those of non-European descent. U.S. President Ronald Reagan, British prime minister Margaret Thatcher, classical pianist Misha Dichter and actors Bill Nighy and David McCallum all dealt with the disorder, which can make it more difficult or even impossible for affected individuals to perform manual tasks such as preparing food, writing, or playing musical instruments.

June 2, 2022 | Dupuytren’s contracture is characterized by a deformity of the hand in which the joints of one or more fingers cannot be fully straightened, their mobility limited to a range of bent or flexed positions. The condition is a disorder of connective tissue, which supports the body’s muscles, joints, organs, and skin. In men, Dupuytren’s contracture most often occurs after age 50. In women, it tends to appear later and be less severe. However, it can occur at any time of life, including childhood. Dupuytren’s contracture often first occurs in only one hand, affecting the right hand twice as often as the left. About 80 percent of affected individuals eventually develop features of the condition in both hands. About one-quarter of people with Dupuytren’s contracture experience uncomfortable inflammation or sensations of tenderness, burning, or itching in the affected hand. They may also feel pressure or tension, especially when attempting to straighten affected joints.

June 2, 2022 | What causes Dupuytren’s contracture remains a mystery, but it’s believed to be hereditary and may be linked to cigarette smoking, nutritional deficiencies or alcoholism. It is linked with some medicines used to treat epileptic seizures. People with diabetes are also reported to have an increased risk of developing Dupuytren’s contracture. The condition usually begins as a thickening of the skin on the palm of your hand. As it progresses, the skin on your palm might appear puckered or dimpled. A firm lump of tissue can form on your palm. This lump might be sensitive to the touch but usually isn’t painful. In the later stages of Dupuytren’s contracture, cords of tissue form under the skin on your palm and can extend up to your fingers. As these cords tighten, your fingers might be pulled toward your palm, sometimes severely. The two fingers farthest from the thumb are most commonly affected, though the middle finger also can be involved.

June 2, 2022 | There are several methods for treating Dupuytren’s contracture. Dr. Theresa Wyrick-Glover, an orthopaedic surgeon at UAMS who specializes in hand, wrist and elbow surgery, says the choice of procedure depends on the severity of the patient’s symptoms and any other health problems they might have. A needle aponeurotomy involves injecting medication into the hand to numb it and using a needle to divide the diseased tissue. Injecting a type of enzyme into the taut cord in your palm can soften and weaken it, allowing your doctor to later manipulate your hand to break the cord and straighten your fingers. Dr. Wyrick-Glover says surgery is usually reserved for those patients with advanced cases of Dupuytren’s contracture. Surgery involves making an incision in the hand and removing any thickened tissue. The advantage to surgery is that it results in a more complete and longer-lasting release than what other methods might provide.

June 2, 2022 | People with Dupuytren’s contracture are at an increased risk of developing other disorders in which similar connective tissue abnormalities affect other parts of the body. These include Garrod pads, which are nodules that develop on the knuckles, Ledderhose disease, which affects the feet, and scar tissue in the shoulder that causes pain and stiffness. Worsening of the contracture may result in deformity and loss of function of the hand. Because the disorder progresses at an unpredictable rate, you should contact your medical provider any of the symptoms. It’s a good idea to see a hand specialist if you lose feeling in your finger or fingers or if your fingers feel cold or turn blue. Even though surgery can usually restore normal movement to the fingers, Dupuytren’s contracture can recur within 10 years after surgery in up to 50 percent of cases. Being aware of the symptoms and any risk factors may lead to early detection and treatment.