The Mysterious Dupuytren’s Contracture

Is your finger mysteriously getting tighter and developing contracture?

Dupuytren’s (du-pwe-TRANZ) contracture is a hand connective tissue disorder. Due to abnormal thickening and shortening of palmar fascia (a layer of fibrous tissue that lies under the skin of your palm), it can gradually lead to flexion contracture in your fingers, causing functional loss of the affected hand.


Dupuytren’s contracture develops gradually over several years. The first sign is often a tender lump in the palm. As it progresses, the skin on your palm might appear puckered or dimpled. In the later stage, tough bands of tissue may develop, and it will become harder to stretch out the fingers.

It most commonly affects your ring finger and small finger. About 80 percent of affected individuals eventually develop features of the condition in both hands.


Causes and Risk Factors

Researchers do not yet know precisely what causes Dupuytren’s contracture (that’s why it’s kind of mysterious to me!). However, a number of factors are believed to increase your risk of the disease, including:

* Ancestry: People of Northern European descent are at higher risk of the disease (it was even called the Viking Disease ! ). (3 to 10 times more common than non-European decent.)

* Age: It occurs most commonly after the age of 50.

* Sex: Men are more likely to develop this condition than women. (4:1)

Tobacco and alcohol use.

* Family history.

* Diabetes.


⭐ Treatments

* Enzyme injections: The enzyme which called collagenase can weaken and soften the taut cord in your palm. After the injection, the doctor will manipulate your hand and try to break the cord and straighten your fingers. However, collagenase injection is expensive (over $3000 per shot), and studies showed the therapeutic effects usually last about 5 years.


* Surgery: Surgery is indicated when the contracture is severely affecting the hand function. The surgeon will release the tight and shortened skin, underlying cords and fascia. Surgery can release the contracture, but it can never cure Dupuytren’s disease.


⭐ Post-op Rehabilitation

* 1 week post-op: wound care, edema control and orthosis fabrication (to keep affected fingers in full extension).

Start moving the fingers to promote tendon gliding and prevent joint stiffness. (We should only do gentle exercises, making sure the wound is not burst open)

Wear the orthosis whole day, only to remove for exercises and skin care.


* 2 weeks post-op: Begin scar management after sutures are removed. To start passive stretching as tolerated.

* 3-4 weeks post-op: Continue scar management and range of motion exercises to regain full finger motion.

* After 4 weeks: To begin strengthening exercises and wear the orthosis at night only for a total of 6 months.


⭐ Summary

Dupuytren’s contracture is a mysterious connective tissue disorder. It can cause severe flexion contracture of the affected fingers, also greatly compromise the hand function. Unfortunately, this disorder is not curable, the current treatments consist of enzyme injection and surgical release.

Rehabilitation is essential after the surgery, it helps to prevent scar adhesion and joint stiffness, also promote tendon gliding, range of motion and hand function!


Andrew Tan, OTR/L, CHT, CKTP, CEAS
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Andrew Tan, OTR/L, CHT, CKTP, CEAS

The founder of "Rehab For A Better Life", specialized in ergonomic consultation, rehabilitation for upper extremity injuries, sports injuries and work-related injuries. Andrew believes rehab-related knowledge should be easy to learn and follow at home, because "knowledge is power only when we can share it" !