Why can’t I straighten my finger?
Dupuytren’s Contracture is a benign disorder of the hand that may result in tightening of the palm and bending of the fingers. When it begins, the palm or finger(s) appear to have bumps and later may develop a rope-y appearance. It is not usually painful, but in some cases, discomfort is reported. The condition is most common in men (almost 5 to 1 versus women) of Northwestern European descent and onset increases with age (over 40).
The condition usually starts with the first knuckle. If it progresses, the middle knuckle may also bend. The fingers most affected are the ring and small, with possible progression to the long, index and thumb. Early signs of Dupuytren’s Contracture may include the appearance of “pitting/dimpling” in the palm. It may become difficult to place the hand on a flat surface, put on gloves, or put the hand in a pocket.
Can anything be done?
According to Dr. Clayton Peimer, a hand surgeon, intervention depends on whether the position of the finger is limiting the ability to perform daily activities. The condition may progress within months, but usually takes years. When the position of the finger is cumbersome, the most effective treatment options to correct deformity include:
- Needle aponeurotomy (NA): A less invasive procedure that uses a needle to perforate the tissue, allowing the physician to then manually straighten the finger, tearing the diseased tissue.
- A two part procedure: A “fasciotomy” using an enzyme called Collagenase that is injected to weaken the tissue, followed the next day by the physician manually straightening the finger.
All of the above interventions come with varying risks, benefits and levels of effectiveness.
Will the deformity return?
There is no “cure” for Dupuytren’s Contracture presently. All corrections risk new disease or recurrence. The rate of recurrence is higher with the needle procedure than with surgery or enzyme injection. If the condition does return after NA, the severity is less among those who have previously had any of the corrective procedures.
Hand therapy following each of the procedures is beneficial. A hand therapist will custom make a post-procedure orthosis to keep fingers fully extended, assist you with tissue healing and scar maturation, and progress toward functional use and strength. Click here to find a Certified Hand Therapist near you, or ask your hand surgeon.
Stephanie Carlson-Ballone, OTD, OTRL, CHT is a Certified Hand Therapist and an active member of the American Society of Hand Therapists. Contributing comments from Clayton Peimer, MD, a Board Certified Hand Surgeon and a Life Member of the American Society of Surgery of the Hand.