• The healthy hand
  • Hand structure and physiology
  • Hand doctors and other clinicians
• Arthritis of the hand
  • Osteoarthritis
  • Rheumatoid arthritis
  • Other types of arthritis that affect the hands
• Special bonus section: Advances in artificial joints for the hand
  • Barbara’s story: Surgery for basal joint arthritis

• Tendon trouble
  • De Quervain’s tendonitis (or tenosynovitis)
  • Trigger finger
  • Tennis elbow
  • Golfer’s elbow
  • Dupuytren’s disease
  • Ganglion cysts
• Exercise for the hand
  • Range-of-motion exercises
  • Strengthening exercises
  • Stretching exercises
  • Resisted isometrics
• Carpal tunnel syndrome and other “pinched” nerves
  • Carpal tunnel syndrome
  • Anne’s story: Coping with repetitive stress injury
  • Cubital tunnel syndrome
  • Radial tunnel syndrome
• Traumatic hand and wrist injuries
  • Wrist sprains
  • Finger sprains, jams, and dislocations
  • Tendon injuries
  • Fractures
  • Finger amputations
• Getting a grip: Handy gadgets and advice
• Resources
• Glossary

Dupuytren’s disease

This uncommon hand problem is also known as Dupuytren’s contracture because it causes the fingers to slowly contract and curl toward the palm. It results from an abnormal thickening of the fascia — the tissue between the skin and tendons — in the palm. Some people develop a tough cord beneath the skin stretching from the palm to the fingers, which prevents the fingers from fully straightening. 

Although no one knows exactly what causes Dupuytren’s disease, it’s almost certainly inherited. Named after the French surgeon who first treated the disease in 1830, Dupuytren’s mostly affects people with Northern European heritage and is more common in men than women. Cigarette smoking, epilepsy, and diabetes may increase the risk for Dupuytren’s.

The condition often begins with a small lump or pit in the palm, usually near the crease of the hand closest to the base of the ring and little fingers. Dupuytren’s disease usually doesn’t hurt, but the initial nodules in the palm may be painful. Still, you may not notice the problem until you cannot flatten the palm of your hand on a table or other flat surface, which may not happen for months or even years. In a poem published in The Journal of the American Medical Association in 2007, a physician affected by the disease described his father’s (and his own) experience with the deformity. He was “puzzled by the stinging and the curl of his fingers about a phantom hardball caught barehanded.” In severe cases, when the fingers pull into the palm, it’s difficult to do everyday activities such as washing your hands, wearing gloves, and putting your hands in your pockets. With Dupuytren’s, it’s impossible to straighten the fingers, unlike a trigger finger, which can be intermittently straightened. Often both hands are affected.

Until recently, people with Dupuytren’s disease were usually treated with surgery to release their bent fingers. Afterward, patients wore splints to keep their fingers straight, followed by therapy to ease swelling and help them regain finger function. But the thickened fascia and cord characteristic of this disease sometimes returned in the same place or elsewhere in the hand. That’s also the case for a less-invasive procedure called needle aponeurotomy or percutaneous fasciotomy, in which the doctor uses a small needle to divide and sever the contracting bands in the palm.

In 2010, the FDA approved a new, nonsurgical treatment for Dupuytren’s disease. Marketed under the name Xiaflex, the drug is made from an enzyme, called collagenase clostridium histolyticum, which breaks down the collagen fibers causing the contracture. A doctor injects the medication directly into the collagen cord in your hand. Twenty-four hours later, your hand is numbed and manipulated to release the cord. Over the following four months, you wear a splint at night that straightens your finger, and perform exercises several times a day to maintain your finger’s range of motion. The most common side effects include swelling, bleeding, and pain in the injected area. Because the treatment involves introducing a foreign protein into the body, serious allergic reactions are possible, but none have been reported to date. In rare cases, the collagenase can leak into the tendon, causing it to rupture — a serious complication.

In a 2009 study published in The New England Journal of Medicine, 308 people with contractures of 20 degrees of more in the MCP or PIP joint of the ring or little finger received injections of either Xiaflex or a placebo. The following day, the investigators manually extended the fingers (as much as patients could tolerate) to break the cord and release the contracture. Subjects could receive up to three injections (at intervals of about one month). Nearly 85% of joints injected with collagenase showed some improvement, compared with 12% of those receiving placebo injections. On average, Xiaflex improved range of motion by 37 degrees, compared with a 4-degree improvement in those who got a placebo injection. Studies show that after two years, recurrence rates were 14% for MCP joints and 23% for PIP joints.

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I found the information very helpful in understanting how the hands function and why problems develop and advise that can be useful to alleviate discomfort.

I found this publication to be very informative. I learned something new every few pages.I'm sure it's going to be helpful to me because my hands are troublesome. Thank you for the great presentation of ideas to assist my dexterity.

A good and easily readable survey of hand function and medical issues. Just enough information, well-organized to help identify issues that may be of interest with potential treatments and strategies without too much medical textbook lecture, just practical information.