Dupuytren's contracture Pic and shape of incision

The most commonly affected digits are the ulnar digits (ring and small fingers).

Dupuytren's contracture is a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. Although painless, the thickening and tightening (contracture) of this fibrous tissue can cause the fingers to curl (flex).

It is more common in men than in women.

The cause of Dupuytren's contracture is not known. It is not caused by an injury or heavy hand use.

Symptoms:
Dupuytren's contracture symptoms usually occur very gradually.

1-Nodules. One or more small, tender lumps (nodules) form in the palm. Over time, the tenderness usually goes away.

2-Bands of tissue. The nodules may thicken and contract, forming tough bands of tissue under the skin.

3-Curled fingers. One or more fingers bend (flex) toward the palm. The ring and little fingers are most commonly affected, but any or all fingers can be involved. As the bend in the finger increases, it may be hard to straighten your finger. Grasping large objects and putting your hand in a pocket becomes difficult.

Treatment:
**Nonsurgical Treatment:

-Steroid injection. If a lump is painful, an injection of corticosteroid - a powerful anti-inflammatory medication - may help relieve the pain. In some cases, it may prevent the progression of contracture. Several injections may be needed for a lasting effect.

-Splints. Splinting does not prevent increased bend in the finger. Forceful stretching of the contracted finger will not help either, and may speed the progression of contracture.
The intralesional enzyme, collagenase clostridium histolyticum, was approved by the FDA in February 2010.

**Surgical Treatment:

Surgery is recommended when joint contracture exceeds 30°, or when nodules are painful and interfere with hand function.

Surgical procedure. Surgery for Dupuytren's contracture divides or removes the thickened bands to help restore finger motion. Sometimes the wound is left open and allowed to heal gradually. Skin grafting may be needed.