Dupuytrens Contrapture

Dupuytren’s Contracture Explained

By: Madison Bambini
Published: November 12, 2019

As we age, it’s crucial to stay on top of our health and recognize when there are shifts in our bodies. By identifying these shifts early on, many health risks and diseases can be treated and prevented before they become too severe. One condition that can benefit from early treatment is Dupuytren’s contracture, a hand deformity that may develop as we age. 

What is Dupuytren’s contracture?

Older patient grasping finger affected by Dupuytren's contracture with other hand.

Dupuytren’s contracture, commonly referred to as Viking’s disease, is a condition that causes abnormal thickening in the palms of the hands. The thickening occurs in the underlying network of tissue beneath the skin of the palm (palmar fascia). Knots of tissue eventually create a thick cord pulling the fingers towards the palm in a bent position. The affected fingers are unable to be straightened completely making it difficult to complete daily activities.

The disease is most prevalent in men over the age of 50, but some may start to see signs as early as 40. Dupuytren’s first presents itself as a small nodule in the palm, generally in the crease of the hand closest to the ring finger and little fingers. As it progresses and the fascia begins to pull, the palm cannot be placed flush on a flat surface. The progression is unpredictable and varies from person to person. Most commonly, patients seek out a specialist because they are concerned about whether or not the lumps growing in their hands are cancerous.

Treatment Options for Dupuytren’s contracture

Dupuytren’s is easily recognizable and does not need X-ray or advanced imaging to diagnose.

When diagnosing the condition, a hand specialist will perform a tabletop test. The doctor will ask you to place the palm of your hand on a flat surface to show how much the fascia has thickened. Surgical and non-surgical treatment involves relieving tension in the cords that are contracting the fingers.

“Treatment is only indicated when there is a progressive deformity in the hand,” said TPMG Orthopedic hand surgeon Nicholas A. Smerlis, MD, FAAOS, CAQSH. “It all depends on how far the deformity has progressed and which joint is being affected.” 

Xiaflex

If the contracture is not too severe, an injectable enzyme used to break down collagen called Xiaflex may be administered to dissolve the cord. Once the cord is weakened, the finger can be straightened in the office to provide improvement. Although, the effectiveness of this treatment is typically shorter than surgery. 

Surgery

The best option for those with advanced disease is a fasciectomy surgery, however, there is a risk of recurrence over time.  During surgery, the thickened tissue is removed to relieve tension and contracture in the hand. The advantage of surgery is the removal of the knots and affected cords with a lower risk of recurrence over time when compared to the injectable.

If severe, the contracture can be a lot harder to fix. Pursuing surgery and hand therapy sooner rather than later can help make recovery time a lot smoother. A certified hand therapist can provide patients with a series of exercises to help strengthen the hand and improve the outcome. With time, there is a 50% chance that the condition will return over ten years. If Dupuytren’s does reoccur, a second intervention may be performed. 

When Should You Seek Treatment for Dupuytren’s contracture?

Dupuytren’s contracture can affect everyday tasks such as wearing gloves and putting your hands in and out of pockets. Surgery can help relieve these annoyances; however, most patients typically do not seek treatment until they consider it a functional problem. A hand surgeon is your greatest resource and can help you choose the best path moving forward. 


About Nicholas A. Smerlis, MD, FAAOS, CAQSH

Nicholas Smerlis, MDBoard certified Orthopedic hand surgeon, Nicholas A. Smerlis, MD, FAAOS, CAQSH has over a decade of experience specializing in the surgical and non-surgical treatment of the hand, wrist, and elbow. Although he specializes in surgery of the hand, not all problems need surgery. Dr. Smerlis often uses non-operative treatments such as medications, splints, injections, and hand therapy to restore function to the hand and wrist. Dr. Smerlis joined TPMG Orthopedics in June 2019 and sees patients in the Newport News and Williamsburg offices.