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Dupuytren’s Contracture

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Dr Jacqueline Tan

MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)

Dupuytren’s contracture, also known as Dupuytren’s disease, is a progressive condition that affects the tissue layer beneath the skin of the palm. It causes the fingers, typically the ring and little fingers, to gradually bend inward towards the palm. Over time, this leads to a deformity that can make daily tasks such as shaking hands, wearing gloves, or reaching into pockets difficult.

The condition develops slowly over years as collagen accumulates in the palm’s fascia, forming thickened bands and nodules that pull the fingers into a curled position.

Symptoms of Dupuytren’s Contracture

The following signs and symptoms typically develop over several years, starting in the palm and potentially affecting one or both hands:

  • Nodules in the Palm: These firm lumps under the skin of the palm develop gradually and may be tender initially. The lumps may feel sore at first, but the discomfort usually resolves over time.
  • Thick Cords Under the Skin: Rope-like bands of tissue form, extending from the nodules toward the fingers. Over time, these cords tighten, causing the fingers to curl towards the palm.
  • Finger Contracture: The affected fingers, most commonly the ring and little fingers, gradually curl toward the palm. This makes it difficult for patients to straighten their fingers, pick up large objects, shake hands, or even wear gloves.
  • Reduced Range of Motion: Daily activities become challenging as finger flexibility decreases and grip strength diminishes.

Causes and Risk Factors

Unlike other hand conditions, Dupuytren’s contracture is not caused by injuries or overuse of the hands. The exact cause is unknown, but several factors may contribute to its development.

  • Genetics: A family history of Dupuytren’s contracture suggests an inherited predisposition, as the condition often runs in families.
  • Age and Gender: The condition is more common in men, particularly those over 50 years of age, with increased risk starting around 40.
  • Medical Conditions: Diabetes and seizure disorders are associated with a higher likelihood of developing Dupuytren’s contracture.
  • Lifestyle Factors: Heavy alcohol consumption, smoking, and occupations or activities involving repetitive hand movements may increase susceptibility.

Stages of Dupuytren’s Contracture

Dupuytren’s contracture progresses through distinct stages, each requiring tailored treatment approaches:

Early Stage

This stage is characterised by nodules and dimpling of the skin in the palm without noticeable finger contracture. The condition may remain stable or progress slowly over time. Regular monitoring is usually sufficient, with no immediate intervention required.

Mild Contracture

At this stage, rope-like cords develop, and finger contracture is less than 30 degrees. The metacarpophalangeal (MP) joint is typically affected first. Conservative treatment options, such as needling or enzyme injections, are often effective.

Moderate to Severe Contracture

This stage involves finger contracture exceeding 30 degrees, often impacting both the MP and proximal interphalangeal (PIP) joints. Surgical intervention is typically required at this stage to restore hand function and improve quality of life.

Diagnostic Methods

Physical Examination

The doctor examines the palm for nodules and cords, tests finger flexibility, and measures the angle of finger contracture. This examination includes the tabletop test, where the patient places their hand flat on a surface to assess severity.

Medical History Assessment

A detailed review of symptoms, progression rate, family history, and impact on daily activities helps determine the condition’s severity and guide treatment planning.

Range of Motion Measurements

Specific measurements of joint angles help document the condition’s severity and track its progression over time. These measurements guide treatment decisions and provide baseline data for monitoring outcomes.

Treatment Options

Treatment approaches vary based on disease severity, progression rate, and impact on daily activities.

Non-Surgical Treatment

Observation

Regular monitoring is appropriate for early-stage disease with minimal symptoms. The doctor assesses the condition’s progression through periodic examinations and measurements.

Needle Aponeurotomy (Needling)

This minimally invasive procedure involves using a needle to break apart the contracted tissue. It is suitable for patients with isolated cords and less severe contractures. The procedure has a short recovery period and can be performed again if the contracture recurs.

Surgical Treatment

Fasciectomy

This procedure involves the surgical removal of the affected fascia through precise dissection. It is typically recommended for extensive disease or recurrent cases. Post-operative rehabilitation is necessary to optimise recovery and restore hand function.

Dermofasciectomy

This technique involves the removal of the affected tissue along with the overlying skin, which is then replaced with skin grafts. It is particularly suitable for aggressive or recurrent cases. The excised tissue is sent for histological analysis to assess any underlying abnormalities.

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Prevention and Management

While preventing Dupuytren’s contracture remains challenging due to its genetic component, certain measures help manage the condition. Regular hand stretching exercises maintain flexibility in unaffected fingers. Protecting hands from excessive strain or injury, maintaining good general health, and attending regular follow-up appointments allow early detection of progression or recurrence.

Frequently Asked Questions

Can Dupuytren’s contracture affect both hands?

Yes, the condition often affects both hands, although the severity may differ between them. Approximately 80% of patients develop contractures in both hands over time.

What is the recovery period after treatment?

Recovery time depends on the type of treatment. Needle procedures generally allow patients to resume activities within days to weeks. Surgical recovery, however, typically takes several weeks to months.

Can Dupuytren’s contracture recur after treatment?

Yes, recurrence is possible after any treatment. The recurrence rate ranges from 20-80%, depending on factors such as the treatment method used, the severity of the disease, and individual patient characteristics.

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Dr Jacqueline Tan

MBBS (SG)

MRCS (Edin)

MMed (Surgery)

FAMS (Hand Surgery)

Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.

  • Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
  • Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
  • Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
  • Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.

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    Mt Elizabeth Novena Hospital

    38 Irrawaddy Road #07-42
    Singapore 329563

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    +65 9230 9554