May 31, 2013
Dear Mayo Clinic:
What causes Dupuytren's contracture? I have been having trouble with my grip and was told I may have this condition. Is it treatable, or will I have it for life?
The exact cause of Dupuytren's contracture is not known, although a number of factors do appear to put people at higher risk for developing this hand disorder. Several treatment choices are available that can help relieve the symptoms of Dupuytren's contracture.
Dupuytren's contracture affects the layer of tissue under your palm, called palmar fascia. Slowly over time, this condition causes knots of tissue to develop in the palmar fascia. Eventually the knots form a thick cord that can pull one or more of your fingers into a bent position. Once this happens, the fingers can't be straightened completely. Dupuytren's contracture most often affects the ring and small fingers, although it can affect any finger. It tends to be painless, with most people having problems such as putting their hands flat on a table or their fingers into gloves.
It is unclear what causes Dupuytren's contracture. Genetics appear to play a role, as the condition is much more common in people of Northern European descent than in other groups. In addition, it can run in families. Some research also suggests regularly drinking large amounts of alcohol increases the risk of this disease. People who have suffered a previous hand injury or who frequently use vibratory tools such as jackhammers that can irritate the tissue of the palm also are more likely to develop Dupuytren's contracture.
Treatment for Dupuytren's contracture depends on its severity. Because it tends not to be a painful condition, the treatment focuses on restoring function. In some people, Dupuytren's contracture progresses very slowly and has little impact on daily activities. In these cases, no treatment may be needed.
In your situation, though, it sounds like Dupuytren's contracture is beginning to have an effect on how you can use your hands. In such cases, treatment usually is needed. For many years, surgically removing the damaged tissue in the palm and then straightening the fingers was the only treatment. Now, other options are available.
One technique uses a needle inserted through the skin to puncture and break upthe cord of tissue. Dupuytren's contracture may return after needle treatment, but the procedure can be repeated. The advantages of using a needle are that it does not require an incision, it can be done on several fingers at the same time, and usually very little physical therapy is needed afterward. Needle therapy may not be appropriate, however, in some areas since it could damage a nerve or tendon.
A more recent treatment advance for Dupuytren's contracture allows doctors to inject a type of enzyme into the cord that's causing the problem. The enzyme dissolves the cord, usually within about one day. Then the next day, the doctor tries to straighten the finger by manipulating what remains of the cord.
With the enzyme procedure, there is a possibility that the enzyme could be accidently injected into the tendon located beneath the palmar tissue. That could lead to a tendon rupture. Because of this risk, it is important to go to a physician who is familiar and experienced with the enzyme treatment.
For most people, treatment can help slow the progression of Dupuytren's contracture and restore hand function. I recommend that you seekcare from a hand specialist who can work with you to determine which treatment option would be best for your situation.
— Sanjeev Kakar, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.