Dupuytren contractures of fingers and lumps in palm

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Dupuytren contracture develops in people who are genetically predisposed. These spontaneous contractures of fingers and thickened lumps in the palm of the hand are the result of a common hereditary disorder that particularly affects in men (men have contractures of fingers eight times more often than women), especially after age 45.  Having the abnormal gene does not guarantee someone will develop Dupuytren.  Approximately 5% of people in the United States have Dupuytren contracture.  When it occurs it will appear in both hands 50% of the time, and when it affects only one hand will be in the right hand twice as often as the left.

Dupuytren’s contracture causes contractures of fingers of either hand with the ring finger (4^th) and little finger (5^th) the most commonly affected, although any and all fingers can be affected.  The contracture of the middle finger (3^rd) can be affected especially in advanced cases, but the index finger (2^nd) and thumb are rarely affected by contractures of fingers.

About the contractures of fingers

Dupuytren causes contracture of fingers when the thin tissue (fascia) (palmar aponeurosis) under the palm of the hand becomes thickened and shortened.  This causes lumps on the palms to follow the contractures of fingers of the tendons, and this causes the fascia to be stuck to the palm of the hand and move less freely. Because of these contractures, the fingers can become permanently flexed or curled down more and more, eventually bringing the tips of the affected fingers closer and closer to the palm of the hand.

The first symptom of Dupuytren contracture is usually a tender lump or nodule in the palm of the hand, most often at the 4^th or 5^th finger.  At first the lump may cause minor discomfort, but gradually becomes painless.  Because Dupuytren’s contractures progress slowly in most cases, it is usually a painless condition; when it advances most rapidly, pain could be moderate to mild, depending on the rate of progression.

Over a variable amount of time the contractures of fingers cause them to assume a curled posture.   As this curling worsens, the hand can become arched or claw-like.

Data about contractures of fingers

•  Ring finger is the most commonly affected finger.
•  Little finger is the second most commonly affected finger.
•  Thumb and index fingers are rarely affected
•  27-68% of cases have a positive family history of Dupuytrens contracture
•  33% of cases involve only one finger.
•  33%of cases involve two fingers.
•  33% of cases involve more than two fingers.
•  65% of cases affect both hands
•  Dupuytren’s is more common in the right hand,
•  The most usual sequence or order the fingers are affected:
Ring
Small
Middle
Thumb
Index

Examination of Dupuytren contracture

Physical examination of the hand and fingers for contractures often confirms the diagnosis without the need for further tests.  Examination reveals a lump or bump or nodule on the palmar side of the hand, that is not tender when pressed or squeezed.  In this area some puckered or twisted looking skin will be seen above the area of finger contracture.  This overlying skin of the palm may adhere to the fascia, with thicker fibrous cord that extends into the finger.  Flexion of the affected finger is normal for passive and active movement, but extension is limited at the knuckle at the base of the finger and sometimes at the first joint above that into the affected finger. Although the contractures of the fingers may cause difficulty grasping objects, muscle strength is normal within the available range of motion.   There is seldom any loss of sensation to touch, temperature and vibration.

Conditions related to Dupuytren contracture

Other disorders share some genetic similarities and fascial involvement that is similar to the process of contractures of fingers of Dupuytren contracture:

Peyronie’s  disease – scar-like nodule formation and shrinking of fascia inside the penis that leads to deviated and painful erections

Ledderhose disease – scar-like nodule formation and shrinking of the fascia on the bottom of the foot that makes walking very painful and difficult

Garrod’s pads – thickening of fibrous tissue above the knuckles

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