When the tissue just under the skin of the palm (i.e., the fascia) becomes thicker than normal, it may be a symptom of Dupuytren's contracture. Sometimes tough cords will show up under the skin between the palm and the fingers and eventually make the fingers bend toward the palm. Internally, parts such as the tendons are usually not affected. Sometimes the disease will cause the top of the finger knuckles or knuckle pads to become thick, and cords or nodules may appear in the soles of the feet, too.
Causes of Dupuytren's Contracture
No one knows what causes Dupuytren's contracture, but there may be some biochemical association with the fascia. Men over forty, for example, are more likely to develop Dupuytren's contracture. However, there is no evidence that it comes from hand injuries or exposure to anything in the workplace.
Signs & Symptoms
Usually there is a small lump or series of lumps and pits in the palm of those who have Dupuytren's contracture. A cord may develop over time and run from the palm to one or more fingers, most likely the ring or middle fingers. The cords look like tendons, but are actually between the tendons and the skin. Many times both hands show the symptoms, but not in an identical manner.
The nodules that show up first may cause a little discomfort when they form, but Dupuytren's contracture isn't usually a painful condition. The first symptom of the disease relates to difficulty with laying the hand down flat on a firm surface. Once the fingers start curling toward the palm, it may become difficult to wash your hands, wear gloves, put your hands in your pockets, or even shake hands with someone. Some people who suffer from Dupuytren's disease might only have small lumps or cords while others can have fingers that are very bent. The more drastic symptoms normally show up if the disease starts earlier in life.
Treatment of the Disease
If the cords have not begun to contract, all that may be needed may involve keeping an eye on them and the nodules. If contraction has started and is severe, hand surgery may be a necessary treatment to get back use of the hand.
Various surgeries can fix the position of the fingers if they have been disturbed. Our hand surgeons will review which surgery is best for you, based on how far along the disease has developed and which joints have been affected. The goal is always to improve the position of the fingers and use of the hand. The disease can show up again, even after surgery, with the fingers once again bending into the palm. A hand surgeon will discuss the results and goals that are likely and realistic.
Below are a few responses to some commonly asked questions:
- Just having a lump in your palm does not signify that the disease will progress or that surgery should be done to remove it.
- The position of the fingers can sometimes be corrected with mild contractures, or with those that change the finger near the base. The fingers, sometimes, can't be completely corrected, especially if changes have happened to the middle and end finger joints.
- If there isn't enough skin to cover open areas in the fingers, skin grafts may be needed to make up the difference.
- Nerves that provide feeling to your fingertips are often tied up with the cords that have developed.
- After the surgery, you may need to wear a hand splint and get hand therapy to develop and keep the fingers in position and working properly.