Dupuytren contracture Kukutitanga ā-matimati (Dupuytren)

It is unknown what causes a Dupuytren contracture. It often runs in families.

You are more likely to get one if you:

• smoke
• drink too much alcohol
• have diabetes or high cholesterol.

Dupuytren contracture is a condition of the hand and fingers or, less often, the feet. Tissue thickens under the skin in the palm of your hand, and a small hard lump or nodule develops. The nodules can be painless or tender. If they are tender, the pain usually goes away after a while.

The nodules can become a cord of tissue. Over months or years, the cords shorten and tighten (contract). This pulls your finger into a permanently bent position, sometimes called a fixed flexion deformity. This is a Dupuytren contracture.

A Dupuytren contracture is often mild and painless, but a nuisance. If it becomes more severe, your bent finger can stop you from being able to use your hand normally.

It often happens on both hands, and most commonly affects the ring or little finger. The most common age to get it is:

• in your 50s for men
• in your 60s for women.

If you think you have a Dupuytren contracture, talk to your healthcare provider.

In most cases, a diagnosis can be made by examining your hand. This may include:

• checking for puckering (wrinkles) on the skin of the palms
• pressing on your hands and fingers to check for hard knots or bands of tissue
• measuring the angle your finger is bent at.

You will not usually need any x-rays, scans or tests.

If you can do the things you want to do with your hands, you may not need any treatment.

Hand therapy, exercises, splints or a steroid injection do not appear to help or change a Dupuytren's contracture.

There are treatment options to consider. They can be:

• needle aponeurotomy
• surgery.

Needle aponeurotomy

During a needle aponeurotomy, a sharp needle is used to puncture the cord that pulls your finger bent. This weakens it and allows the tightness to be released. This is done under local anaesthetic, which numbs the part of your hand being treated. It is suitable for some Dupuytren contractures and tends to be used more in the earlier stages.

People recover more quickly from this procedure than they do from surgery. In some people, the contracture may come back more quickly than after surgery.

This procedure is also called a needle fasciotomy.

Surgery

If you cannot use your hand easily, you may need surgery. This will depend on several things, including what angle your finger is bent at. The surgery aims to help your hand work better and to stop it from getting worse.

Seeing a hand therapist is important to help you recover from surgery. It may include:

• a splint to help hold your finger straight overnight
• wound and scar management
• exercises to regain finger movement and strength.

Find a therapist — Hand Therapy New Zealandexternal link

It often takes 8 weeks or so before your hand feels normal again, but you will get better week by week.

Only do as much as you are comfortable with. If your hand becomes painful and swollen, you are doing too much.

You will need to avoid firm grasping or lifting for 6 to 8 weeks.

You may be off work for a short time, depending on your job. Some people can go back to work after a week, while others might not be able to do heavier work for 8 weeks or more.

If you are severely affected by your contracture, you may be eligible for publicly-funded surgery. Ask your healthcare provider if you should be referred to a surgeon.

About 20% of people who have surgery find that the contracture comes back. This mostly happens years after the surgery. Usually, it is not as bad as it was before the operation.