Dupuytren’s Contracture

Background

A dupuytren’s contracture is a benign proliferative disorder, with a genetic component affecting the connective tissue in the palm of the hand called the palmar fascia. This extra contractile tissue develops over time and causes a deforming contracture in the palm and fingers. Dupuytren’s is most common in males and usually occurs during the 5th-7th decades of life. The ring and little fingers of the hand are most commonly affected. The condition usually begins as a thickening of the skin on the palm of the hand. As the condition progresses, the skin in the palm might appear puckered or dimpled. A firm nodule can form in the palm. This lump might be sensitive to the touch but usually is not painful. Over time, a palpable cord develops and causes further contraction.

Treatment

Non surgical options include hand range of motion exercises and Clostridium histolyticum collagenase (Xiaflex) injections, depending on severity. If a palpable and contracture cord is present, a Xiaflex injection can be performed. This procedure includes injecting an enzyme into the cord which will degrade the injected tissue. The patient then returns to the clinic 48 hours after the Xiaflex injection where anesthetic is injected around the contracture. After adequate anesthesia is obtained, the finger and hand are manipulated to disrupt the cord and restore motion. Possible complications include pain, skin tearing at the contracture site, infection, and inadequate results. If inadequate results occur, then another injection and manipulation can be performed a month later. After the manipulation, the finger(s) will be splinted at night for up to 4 months to maintain the range of motion. The patient will also perform flexion and extension range of motion exercises several times per day for a few months.