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DUPUYTREN'S CONTRACTURE
Dupuytren's disease is a thickening and shrinking of the layer of flesh just under the skin of the palm. It can cause lumps or dimples in the skin of the palm, and can draw the fingers down into a bent position. It is named after a surgeon who wrote about its treatment

Cause
There is a layer of tissue, called fascia, under the skin of the palm which helps keep the the skin from sliding around when you grip things. In some people, this tissue shrinks, and pulls on the skin and on the fingers.

The ring and the small fingers are affected more often than the others, although any or all of the digits may be involved.

The problem appears to be inherited, and usually begins in adulthood for no clear reason. It is painless and benign, but unpredictable - some people will only have a lump, others a very difficult problem with severely bent fingers.

What Can You Do?
Unfortunately, not much other than wait and watch. Have it checked out to confirm that this is the problem, and don't wait until the fingers are bent into a fist.

What Can a Doctor Do?
Confirm that this indeed is the problem with your hand. Dupuytren's is sometimes confused with Trigger finger, which can result in bent fingers, but is an entirely different process.
Perform surgery to remove the abnormal tissue, usually through zig-zag cuts in the palm. Surgery may require skin grafts or other tricks to correct the tightness of the skin of the palm. Surgery is usually recommended to help straighten out bent fingers rather than to prevent the fingers from becoming bent. A variation of surgery is a minimally invasive procedure referred to as a Needle Aponeurotomy. In this procedure, the abnormal tissue is weakened using a small needle in the palm. Needle Aponeurotomy is most effective for disease in the palm of the hand, but can be used in certain cases of finger contractures.

A variety of medications have been tried over the years, including colchicine, verapamil, cortisone and collagenase (FDA approval pending), but a medical cure is not yet available.

How Successful it Treatment?
It depends on how bad the problem is, as well as the person's age, sex, and other medical problems.
Most people who have had surgery for Dupuytren's feel that they made the right choice to have surgery.

Taking all comers, most people who have surgery for Dupuytren's contracture will have similar problems later on - either developing elsewhere in the hand or coming back in the area of previous surgery. Dupuytren's is a chronic, recurrent disease.

Dr. Kilaru can help you make the right decision in choosing the best treatment.

What Happens if You Don't Have Treatment?
It depends on how much it is bothering you - it really is a quality of life issue. This is not a problem which can spread to other parts of your body. Many people have thumb pain which subsides after a few years, when the arthritis and irritation in this joint "burns out".

However, there probably is a limited period of time during which surgery can give the best result. After a period of years, the thumb weakness and the loss of motion of the thumb may not be reversible even with surgery.

The main reason to do surgery is to relieve pain and, when possible, prevent the progressive weakness and deformity which may occur. Some people will have a mild problem which flares up from time to time, and treat it themselves or ignore it, others will have a severe problem which prevents them from doing many things with their hand, and feel that they have no choice but to have surgery.