Dupuytren’s Contracture: Causes and Risk Factors

Dupuytren’s contracture, also known as Dupuytren’s disease, is a hand deformity that causes the tissue beneath the surface of the hand to thicken and contract. The condition has been associated with diabetes and with seizure disorders such as epilepsy.

Evidence of Dupuytren’s usually begins with a thickening of the palm. One or more lumps beneath the skin of the palm may appear, usually near the base of the ring or pinkie finger.

As the disease progresses, these lumps - or nodules - develop into hard cords or bands that extend into the fingers. The cords eventually contract, making it impossible to extend the fingers. Routine activities such as washing dishes and shaking hands become difficult or impossible.

What are Dupuytren’s Contracture Risk Factors?
Although many have never heard of Dupuytren’s, hand surgeon Keith Segalman sees patients with the condition every day in his surgical practice at the Curtis National Hand Center and Greater Chesapeake Hand Specialists in Maryland.

While the condition is relatively common, its precise origin remains a mystery. "We've detected many associations, but no clear cause," says Segalman.

Here’s what experts know about Dupuytren’s:

• The condition has been associated with diabetes and with seizure disorders such as epilepsy.
  Experts don't know the reason for the link in either case. Segalman adds that Dupuytren’s symptoms are typically less severe in patients with diabetes, again for reasons that are not fully understood.
• Dupuytren’s is hereditary.
  “The disease runs in families," says surgeon Taizoon Baxamusa, a spokesperson for the American Academy of Orthopaedic Surgeons and an associate clinical professor of orthopaedic surgery at the University of Illinois in Chicago. This doesn't mean that because your father had Dupuytren's, that you'll automatically develop it too. But your risk is definitely higher, according to Segalman.
• Ancestry plays a key role.
  Dupuytren’s disease is seen most often in people of Northern European (English, Scottish, Irish, Dutch, French) or Scandinavian (Danish, Swedish, Norwegian, Finnish) descent. But individuals of all races and ethnicities can develop it.
• Gender and age are risk factors.
  Men are far more likely than women to develop Dupuytren’s contracture, and the condition usually appears after the age of 40. When women develop the condition, they tend to do so later in life, and have milder symptoms.

Although injury and excessive hand use are not believed to cause Dupuytren’s, higher rates of Dupuytren’s disease have been observed in people with hand trauma.

Patients often assume a connection because they may experience initial symptoms when engaged in activities involving the hands. “Since this disease is most common in older men, some men first notice a nodule on their palm when they’re playing golf and assume that holding the club caused the condition," says Baxamusa.

While some experts cite alcohol and tobacco use as possible risk factors, Segalman calls this a "soft" association that hasn't been firmly established. He adds that people of Northern European and Nordic descent tend to have higher rates of alcohol consumption in general, so it is difficult to identify a definitive connection.

Dupuytren’s: The Prognosis 

Centuries after it was first identified, the origins of this puzzling condition are still not understood. And while modern science has developed a number of effective treatments to provide temporary relief, there is no cure.

Specialists who work with Dupuytren’s patients every day, like Segalman and Baxamusa, say that recurrence rates are high. After treatment, symptoms are likely to recur.

"The good news is that Dupuytren’s is a painless condition, and most patients who receive treatment have satisfactory outcomes, as long as their expectations are realistic. The bad news is that even with treatment, this condition isn't going away," says Baxamusa.


Thank you Constance Matthiessen