Houston Methodist. Leading Medicine

Hand FAQ


I'm starting to develop a problem the doctor called Dupuytren's. It's not too bad right now but I'm wondering if it gets worse, what might I expect?


Dupuytren's contracture is a fairly common disorder of the fingers. It most often affects the palm side of the ring or little finger, sometimes both, and often in both hands. Just under the palm is the palmar fascia, a thin sheet of connective tissue shaped somewhat like a triangle. This fascia covers the tendons of the palm of the hand and holds them in place. It also prevents the fingers from bending too far backward when pressure is placed against them. The fascia separates into thin bands of tissue at the fingers. These bands continue into the fingers where they wrap around the joints and bones. Dupuytren's contracture transforms the fascia into shortened cords. As a result, a thick nodule (knob) or a short cord in the palm of the hand slowly forms, just below the ring finger. More nodules form, and the tissues thicken and shorten until the finger cannot be fully straightened. Dupuytren's contracture usually affects only the ring and little finger. The contracture spreads to the joints of the finger, which can become permanently immobilized. The condition occurs most often in middle-aged, white men. The disease usually doesn't cause symptoms until after the age of 40. This condition is seven times more common in men than women. Although more common in men of Scottish, Scandinavian, Irish, or Eastern European ancestry researchers agree that genes are not a direct cause of this disease, but predisposes them to this condition. Symptoms may be mild at first and only affect one joint of one finger. Over time, other joints and other fingers may be affected. Patients report difficulty putting the affected hand in a pocket and difficulty picking up or holding small objects like coins or keys. It can become impossible to pick up a coffee mug or hold the dog's leash with more than the thumb and first two fingers. Even things you might take for granted otherwise become difficult: plumping up a pillow at night, using toilet paper to wipe yourself, putting on face cream. There's no real evidence or consensus on when is the best time to treat this problem. The recurrence rate is high (between 30 and 60 per cent). Studies are needed to compare no treatment versus early treatment versus late treatment with the various different treatment options (conservative and surgical). Neal C. Chen, MD, et al. Cost-Effectiveness of Open Partial Fasciectomy, Needle Aponeurotomy, and Collagenase Injection for Dupuytren Contracture. In The Journal of Hand Surgery. November 2011. Vol. 36A. No. 11. Pp. 1826-1834.

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