Dupuytren's Contracture Disease

Dupuytren's contracture (also called Dupuytren's disease, Morbus Dupuytren, Viking disease, and Celtic hand) is a connective tissue disorder in which the tissue under the skin of the palm of the hand thickens. It can affect one or both hands and most often involves the ring finger and little finger (pinky finger).

Dupuytren's contracture is a progressive disorder that worsens over many years. The disease causes the fascia (connective tissue underneath the skin) to thicken and tighten over time, resulting in the fingers being pulled inward, called a "Dupuytren's contracture." This can make it difficult for patients to perform daily activities.

While Dupuytren's contracture can appear in men, women, or children of any age or background, it is more commonly seen in:

• Men
• People over age 40
• People of northern European descent

It is believed genetics plays a role in the development of Dupuytren's disease. There is a family history of Dupuytren's contracture in up to 70% of those who develop the condition. Injuries to the hand have also been reported to trigger the disorder.

Aside from being male, over 40, and of Northern European descent, risk factors developing Dupuytren's contracture include:

• Diabetes
• Use of anti-epilepsy drugs such as phenobarbital
• Smoking
• Liver disease
• Heavy alcohol consumption
• Tuberculosis
• Certain medications (isoniazide, tetracycline and fluoroquinolone antibiotics, ropinirole, metoprolol, vemurafenib)
• High cholesterol
• Thyroid problems
• Previous injury to the hand

In the beginning, the only symptom of Dupuytren's contracture may be thickened skin on the palm of the hand. This symptom usually does not cause any pain or problems. Dupuytren's may affect one or both hands, and each hand may be affected differently.

Other symptoms of Dupuytren's contracture include:

• Hard bumps (nodules) under the skin on the palm
• Pits within the palm
• Bands (cords) of thick tissue under the skin on the palm
• Finger joint stiffness
• Bending fingers
• Difficulty straightening fingers (typically the ring and little fingers

Usually the first symptom of Dupuytren's contracture hard lumps (nodules) on the palm. Nodules may be followed by pitting of the skin near the lumps. The skin may appear as if it's being pulled down into the palm of the hand.

Bands of thick tissue (cords) run down the palm and can often be felt before they are seen.

After some time, usually years, finger bending (contracture) occurs. The affects fingers often do not straighten completely, and in severe cases they may bend into the palm of the hand.

Treatment of Dupuytren's contracture depends on the severity of the symptoms.

In mild cases, no treatment may be needed. Modifying tools (such as cushioning handles or using padded gloves) can assist with tasks that require grasping. Massage or hand exercises to keep fingers flexible may help reduce pain and maintain hand function.

In severe cases, treatments include:

• Radiation – High doses of X-rays are aimed at the hand and this may slow or stop the progression of the disease but is only effective during the active phase of the condition when nodules are growing and cords are developing.
• Needle Aponeurotomy - A doctor sticks a needle in the palm to break apart the thick tissue.
• Medications – collagenase injection (Xiapex) into the palm can help soften and break up thick tissue.
• Surgery – There are different types of surgery used to remove or break apart thick tissue.

Dupuytren's contracture does not go away on its own. It is a slowly progressive condition. Treatment does not stop the condition from worsening, but it can help manage and reduce symptoms.

In mild cases of Dupuytren's disease, the condition progresses slowly and patients may never need treatment.

In severe cases, the fingers contract and curl toward the palm, which can make daily activities difficult. The most severe form of Dupuytren's contracture is called "Dupuytren's diathesis." In this form, the condition develops at an early age, both hands are affected as are most fingers on each hand, the condition progresses more rapidly, and it is more likely to recur even after treatment.

There is no known cure for Dupuytren's contracture but surgery and other treatments can restore some hand function.