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Dupuytren's contracture is a relatively common condition caused when the fibrous tissue in the palm of the hand thickens and shortens. It most common in North European Caucasian males and is treated with open surgery known as Palmer Fasciectomy or the less invasive surgical procedure called Needle Fasciotomy
Dupuytren’s contracture is the thickening and shortening of the connective tissue (fascia) in the palm of your hand. It is a common condition that is benign (non cancerous), painless, but gradually progressive, which means that it becomes worse over a period of time.
More men than women are affected with Dupuytren’s contracture and it occurs most often in later life and affects around one in six men over 65 in the UK. This makes it relatively common.
Owing to the thickening of the connective tissue, lumps or dimples appear in the palm of your hand. Over a period of several years the tissue can also begin to contract (shorten), which causes difficulty extending the fingers. The fingers can eventually be pulled into a permanently contracted or bent position.
The ring finger is normally the first affected, followed by the little finger, and then the middle finger. The condition normally affects both hands, although not in every case.
The cause of Dupuytren’s contracture is not exactly known, although it has a tendency to run in families. In most people no specific cause is discovered. However it tends to be more common in people with cirrhosis of the liver, epilepsy, diabetes or alcohol dependence.
If the Dupuytren’s contracture is mild, no treatment may be necessary. However if the hand is affected significantly, and normal functions are restricted, surgery may become necessary.
The only treatment option that is successful over the long-term is open surgery. This involves cutting out or dividing the thickened tissue in your hand by cutting a zig-zag shaped wound in the palm of the hand and possible up the finger, so that the fingers are able to straighten. This procedure is known as an palmer fasciectomy. It can either be done as a day case or involve an overnight stay. The procedure can be done under local or general anaesthetic.
Needle fasciotomy is an alternative procedure that can improve the symptoms of Dupuytren’s contracture without the need for open surgery or a stay in hospital. With this outpatient procedure, the contractures are divided using a blade or needle. Although research shows that there is a 50% chance of the condition returning within 3-5 years after this procedure, needle fasciotomy can be repeated at that time.
Complications of this surgery usually include wound infection, possibly requiring antibiotics. Also, as the nerves which travel to the fingers are located close to the operation site, they are susceptible to mild stretching or bruising. This has the effect of temporarily causing numbness or tingling in one or more fingers.
If a nerve is completely severed or cut, then the numbness to that part of the finger will be permanent. Rarely, the operated hand can become stiff, swollen and painful. This condition is called algodystrophy and usually requires rehabilitation from a physiotherapist.
Very rarely, more serious complications arise, especially in those suffering from diabetes or illnesses affecting the circulation. If the blood supply to the finger is blocked, then their is a risk of gangrene of that finger, possibly requiring further surgery. Fortunately, this is extremely rare.
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