Dupuytren's Contracture

  • Helen McLachlan MSc Molecular Biology & Pathology of Viruses, Imperial College London

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Dupuytren’s contracture is a benign hand condition characterised by restricted movement in the hand and fingers, most often affecting the two fingers furthest from the thumb. In most cases the condition does not cause pain in the patient but can make performing daily tasks more challenging, impacting quality of life. In this article we will look at risk factors, causes and possible treatments for Dupuytren’s contracture. 

What is Dupuytren's contracture?

Dupuytren’s contracture is a fibroproliferative disorder of the hands, which affects approximately 8% of the global population.1 Fibroproliferative is a term used to describe conditions which involve an increase in the number of fibroblast cells, cells which are an essential component of connective tissue and necessary for wound healing.2 

The condition was first documented in 1614 by Henry Platter and in 1831 Guillaume Dupuytren, a French anatomist and military surgeon, gave a detailed surgical demonstration of the disease which gave the condition its name.3

How does Dupuytren’s contracture develop?

In the early stages of the disease, knots of tissue (nodules) form on the palm of the hand, which may resolve themselves without medical attention or any kind of treatment. However, in some cases the disease progresses. Progression of the disease appears to occur in three phases: Proliferative, involution, and residual.

In the proliferative phase there is usually high number of juvenile fibroblast cells in the hand, this is followed by these cells aligning along vertical lines of tension in the hand during the involution stage to form cords of thickened tissue. Fibroblasts produce collagen, a structural protein which is a key component in connective tissue and essential for maintaining healthy skin and joints. In excess quantities however, collagen can have negative effects, such as causing tissues to become stiff and thicken. 

Fascia is a thin connective tissue found throughout the body which covers: organs, muscles, ligaments, blood vessels, nerves and bones and helps to keep them in place. The palmar fascia, which occurs in a triangular shape in the palm of the hand, is affected in Dupuytren’s contracture and becomes thickened due to excess collagen. In the residual phase of the disease these collagen rich cords remain, which reduces mobility in the hand and pull the fingers towards the palm of the hand leaving them in a flexed position.4 

Causes

The exact cause remains unknown, though research has shown that the immune system may play a role due to the high number of immune cells, growth factors and signalling proteins found in Dupuytren nodule tissue samples.5 Genetics have also been highlighted as a causal factor but further research is required to establish the mechanisms involved. 

Risk factors

Research has shown there is a wide range of risk factors including:

  • Age – more common in patients over the age of 60
  • Gender – more common in patients assigned male at birth 
  • Diabetes
  • Genetics
  • Heavy smoking
  • Ethnic background – more common in patients of Northern European descent
  • Alcohol consumption
  • Previous injury
  • Manual labour

Symptoms

Clinical presentation of symptoms can be graded6 according to the following:

  • Grade 1 – thickened nodule or lump occurring in the palm of hand, puckering of the skin is also observed
  • Grade 2 – nodules and some limitation to range of motion
  • Grade 3 – nodules accompanied by more chronic loss of joint motion

If Dupuytren’s has progressed patients may find it difficult to use their hands which can lead to difficulties in completing everyday tasks, for example: getting washed, buttoning/unbuttoning shirts, holding and using objects. As a result, the mental health of patients can often be negatively affected7 leading to feelings of:

  • Shame and embarrassment
  • Fear of pain and causing damage to the hand
  • Self-consciousness regarding age

Diagnosis

Dupuytren’s contracture is usually diagnosed by visually assessing the hands and also feeling them to identify any knots and noticeable bands of tissue. In some cases your healthcare professional may carry out what is known as “the tabletop test” in which they ask you to lie your hand flat on a surface – the inability to do so can be an indication of Dupuytren’s contracture.

X-rays are not usually required to diagnose Dupuytren’s contracture, but can be used to eliminate alternative diagnoses such as arthritis. 

Treatments

There is no cure for Dupuytren’s contracture, however, there are a number of medical treatments which have shown to be effective in alleviating symptoms. Dupuytren’s contracture can often be painless, but varies patient to patient, if you are experiencing any pain you can always take a painkiller such as paracetamol or ibuprofen. Alternative treatments detailed here are: surgery, collagenase injections and needle aponeurotomy.

Surgery

Surgical interventions are the most popular option for treating patients with Dupuytren’s contracture. Palmar fasciectomy is the most commonly accepted procedure to remove the fibrous fascia layer from the hand, restoring mobility and hand function. However, this is usually an option for patients with more severe contractures.

Splinting

Splinting is often recommended as a post-operative measure to optimise finger extension.8 Dynamic and static splints can be used for Dupuytren’s patients, immobilising the fingers and preventing them from curling into the palm of the hand. 

Collagenase injections

Collagenase is an enzyme which breaks down peptide bonds in collagen, which when administered to patients can successfully degrade the collagen-rich cords, significantly improving range of motion and reducing contracture.9

Needle aponeurotomy

Depending on the type of cord contracture a patient has, a procedure known as needle aponeurotomy can be used to restore hand and finger movement. This is a less invasive alternative to a palmar fasciectomy in which a hypodermic needle is used to sever the thickened cords.

Medical professionals will often recommend physical therapy exercise to patients, which involves the stretching, straightening and flexing of each finger and can be done alongside other treatments. 

FAQs

Can Dupuytren’s contracture be cured?

No, there is no cure currently available, however a number of treatments exist which can help to alleviate symptoms.

How long will it last?

In many instances following onset Dupuytren’s contracture is progressive, as there is currently no cure which means it can worsen with time. However, some patients have reported that their condition has stabilised or even regressed as not all incidences of the disease are progressive.

What causes the condition?

The exact cause remains unknown, though research has shown genetics play a strong role which needs to be further understood.

Which treatments are available?

There are a number of treatments available, the most popular is surgery, while collagenase injections and needle aponeurotomy are also successful options. Physical approaches such as stretches and exercises can also be very helpful, but it is important to note although treatments can minimise the severity of symptoms they are not always able to prevent reoccurrence.

Summary

Dupuytren’s condition is benign and causes the development of thick collagen-rich cords in the hand which can cause fingers to curl into the palm of the hand. This can make performing everyday tasks challenging, which can impact a person’s quality of life as well as their self-esteem and mood. For this reason it is important to seek a diagnosis and professional advice if you suspect you have Dupuytren’s condition and are finding yourself in any discomfort. There are a number of treatments available which can significantly restore hand motion and function, although it is important to remember that these treatments are not always able to prevent recurrence.

References

  • Salari N, Heydari M, Hassanabadi M, Kazeminia M, Farshchian N, Niaparast M, et al. The worldwide prevalence of the Dupuytren disease: a comprehensive systematic review and meta-analysis. J Orthop Surg Res [Internet]. 2020 Oct 28 [cited 2024 Jan 15];15:495. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594412/
  • Dick MK, Miao JH, Limaiem F. Histology, fibroblast. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2024 Jan 15]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK541065/
  •  Rayan GM. Dupuytren disease: Anatomy, pathology, presentation, and treatment. J Bone Joint Surg Am [Internet]. 2007 Jan 1 [cited 2024 Jan 16];89(1):189–98. Available from: http://www.ejbjs.org/cgi/content/full/89/1/189
  •  Walthall J, Anand P, Rehman UH. Dupuytren contracture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2024 Jan 18]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK526074/
  • Bianchi E, Taurone S, Bardella L, Signore A, Pompili E, Sessa V, et al. Involvement of pro-inflammatory cytokines and growth factors in the pathogenesis of Dupuytren’s contracture: a novel target for a possible future therapeutic strategy? Clinical Science [Internet]. 2015 Oct 1 [cited 2024 Jan 18];129(8):711–20. Available from: https://portlandpress.com/clinsci/article/129/8/711/71314/Involvement-of-pro-inflammatory-cytokines-and
  • Hart MG, Hooper G. Clinical associations of Dupuytren’s disease. Postgrad Med J [Internet]. 2005 Jul 1 [cited 2024 Jan 18];81(957):425–8. Available from: https://europepmc.org/articles/PMC1743313
  • Turesson C, Kvist J, Krevers B. Experiences of men living with Dupuytren’s disease—Consequences of the disease for hand function and daily activities. Journal of Hand Therapy [Internet]. 2020 Jul 1 [cited 2024 Jan 18];33(3):386–93. Available from: https://www.sciencedirect.com/science/article/pii/S0894113018302965
  •   Larson D, Jerosch-Herold C. Clinical effectiveness of post-operative splinting after surgical release of Dupuytren’s contracture: a systematic review. BMC Musculoskelet Disord [Internet]. 2008 Jul 1 [cited 2024 Jan 18];9:104. Available from: https://europepmc.org/articles/PMC2518149
  • Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FTD, Meals RA, et al. Injectable collagenase clostridium histolyticum for dupuytren’s contracture. N Engl J Med [Internet]. 2009 Sep 3 [cited 2024 Jan 18];361(10):968–79. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMoa0810866

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Pippa Chapman

MSc, Immunology, University of Strathclyde

Pippa is a Cell Culture Scientist who after completing an MSc in Immunology has been employed in the biotechnology sector. She has a strong interest in medical research and the application of both conventional and holistic strategies to tackle today's most challenging health conditions.

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