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By David R. Gentile, MD, FACS

 

Dupuytren’s contracture is a rare connective tissue disorder of the fingers that results in the fingers being in a permanently flexed position.  The exact cause is not known but Dupuytren’s disease seems to occur in individuals with a strong family history of the disease, diabetes, seizure disorder, smoking and associated lung disease, alcohol use, and HIV infection.

Anatomically, there is a shortening of the cord-like bands of tissue on the palm side of the hand.   A nodule may develop and, over time, fibrotic or hardened tissue may develop.  The condition affects men ten times more frequently than women and is associated with northern European ancestry.

Conservative treatment is non-surgical and it consists of continued observation of the issue. Dupuytren’s nodules may respond to steroid injections with a decrease in pain associated with the nodule however the nodule does not usually resolve following injection.  Surgery is generally recommended when the patient cannot place the palm and fingers flat on the table.   Recently, enzyme injection of the pathologic cord and manipulation has developed as a preferred treatment to minimize recovery and allow patients to return to work earlier.