Dr. Steven H. Goldberg answers your questions about Dupuytren’s contracture.
I noticed a new lump on the palm of my hand, and I noticed my tendon is visible and tight where I can’t fully straighten my finger. What could this be?
Dupuytren’s contracture, or fibromatosis, is a condition that can cause lumps on the palm of the hand; it also causes cords on the palm or fingers. The cord is not the tendon but rather a thickening of the fascia, a normal structure below the skin. The cord contains myofibroblasts which have a muscle-like quality that pull on the skin causing puckering, dimpling, and bending of the finger. The lumps and cords can also occur on the soles of the feet. Some people are more likely to have this disease due to genetics.
How do you know this lump is Dupuytren’s and not cancer?
Most lumps in the palm are not cancerous. Skin cancers are more common in sun-exposed areas, so a lump on the back of the hand is more likely to be cancerous compared to one on the palm. Dupuytren’s lumps in the palm of the hand most commonly form in the ring and small finger. Skin puckering or dimpling can occur, and you typically can’t fully straighten your fingers. This loss of motion is less common with other masses or tumors. Dupuytren’s lumps are typically not painful and usually do not grow much. A more worrisome bump or lump is often painful, can have rapid growth, and can either be painful at night or when resting. If a patient is very concerned about the lump, it can be surgically biopsied to confirm it is Dupuytren’s contracture.
Aren’t there any tests you can do? I want a MRI.
There are not any diagnostic lab or imaging studies, such as an x-ray, ordered for Dupuytren’s. It is usually diagnosed based on your history and a physical examination by your doctor. It can also run in families, so it is helpful to ask about relatives who may have had bent fingers. It is more common as one gets older. It can be more common in Northern European ancestry, diabetics, smokers, and men. Since the lump is easily felt and well-defined, tests such as x-rays are rarely necessary.
Since the lump and cord do not really hurt, when should I have it treated?
A good sign that you should see a hand surgeon is if you can’t put your hand flat on the tabletop, if you have trouble reaching in the front pocket of a pair of jeans, if it is awkward shaking hands, or if you have any concerns about the palm of your hand. In fact, it is never too early to have a hand surgeon perform a physical exam and reassure you. Just because you see a surgeon does not mean you need surgery.
Does this spread to other fingers?
No. Sometimes one finger is involved, and sometimes multiple fingers are involved. Each patient is different. There are no dietary or lifestyle changes you can make, vitamins or medications you can take to change when or how severe this disease will come on. Therefore, it is best not to worry about what might happen and consider treatment decisions based on current function and symptoms.
Do all finger joints respond equally to treatment?
No. Each joint is different. There are three finger joints:
- The distal interphalangeal joint: This is at the fingertip near the base of the fingernail. It is rarely involved, and fewer problems occur when it is mildly bent.
- The proximal interphalangeal joint: This is in the middle of the finger. It can be frequently involved. It is recommended to treat this joint as soon as it does not fully straighten so it can potentially return back to normal.
- The metacarpophalangeal joint: This is where the finger meets the hand. Even when this joint is bent down much further it can often fully straighten again.
I want my finger straighter. Can you just order some therapy?
Therapy can be safe to try, but the thick bands of fascia are not elastic, so the likelihood of straightening the finger is very low. Therapy is used more often to maintain, not improve, motion with some home exercises and to help provide advice on how to monitor symptoms. Therapy is also utilized to make custom splints after other treatments such as surgery, needle procedures or injection.
I want my finger straighter. What are my options?
There are several available treatments for this disease, including:
- Surgery that will remove the fascial bands and lumps. This a common out-patient procedure with good long-term success.
- Surgery called fasciotomy can cut the cord without attempting to remove all of the abnormal fascia.
- Collagenase enzyme injection is a procedure that more patients are undergoing in recent years. It is followed up by a visit in 1-3 days to numb the finger and manipulate the finger into straightening.
- Needle aponeurotomy is another office procedure.
To determine the best treatment option for you, it is best to find a hand surgeon. Oral medication and steroid injections are not suggested to treat Dupuytren’s.
Is Dupuytrens’ curable?
No, but it is very treatable. After treatment, it can come back. Sometimes bands will reform within the first 6-12 months. This is more common in patients with a strong family history, multiple finger involvement on both hands, foot involvement, and patients who suffered from the disease early on. Recurrence does not mean your surgeon did something incorrectly or that someone else can do better. Dupuytren’s contracture is not dangerous, and it does not return in all people. It can be repeatedly treated with either surgery or collagenase, so learning more about it and having a hand surgeon you trust will help you achieve a good outcome.
Steven H. Goldberg is Board Certified in Orthopaedic Surgery and is a Fellowship Trained Hand Surgeon with The Subspecialty Certificate in Surgery of the Hand. Dr. Goldberg completed his residency in Orthopaedic Surgery at Rush University Medical Center in Chicago and his fellowship in Hand and Microvascular Surgery as the Robert E. Carroll Fellow at Columbia Presbyterian Medical Center in New York City. He has been a member of the American Society for Surgery of the Hand since 2010 and serves on the Physician Coding and Reimbursement and Public Education Committees. He is a representative of the ASSH for the CPT Editorial Panel of the American Medical Association. He was previously a partner with Hand Surgery Ltd in Milwaukee and currently practices as an Associate in the Department of Orthopaedic Surgery, Geisinger Medical Center.