The Medical Minute: Doctor, why are my fingers curling up?

Dec 02, 2010 By Alexander Payatakes

Dupuytren's (pronounced DOO-pwee-trens) disease or contracture is an abnormal, progressive thickening of the fascia of the hand (the layer underneath the skin). The disease is inherited, and a patient’s children have at least a 50 percent chance of carrying the abnormal gene. The severity of the disease, however, may vary greatly (new patients are often unaware of any family members having the disease). It is much more common in people of Scandinavian, British or eastern European descent.

The typical patient is more than 40 years old, with men affected more often than women. Diagnosis is typically made based on physical examination alone. Characteristic findings include nodules (lumps) in the palm, pitting of the skin, thick cords under the skin, and contractures (curling of the fingers). The pinkie and ring fingers are most commonly affected. Your doctor will rule out other conditions that may present in a similar manner, such as trigger fingers (a much more common condition), nerve or tendon injuries and skin tumors.

Does a diagnosis of Dupuytren’s disease mean that surgery is necessary? Well, it depends. Surgery is recommended if and when significant curling of the fingers is present. An easy way to evaluate this is the so-called table-top test. If the patient is able to place the involved hand(s) flat on a table (palm-down), then observation alone is recommended. Indicators that significant progression is likely to occur include a strong family history, early presentation, involvement of both hands and involvement of the feet (tender lumps in the arch).

If surgery is necessary, several options are available. Over the past few decades, the mainstay of treatment has been partial fasciectomy, which consists of removing the diseased tissue, while taking care to avoid injury to the nerves and vessels. Other possible complications include wound healing problems, pain, stiffness and recurrence. Rehabilitation may be extensive, and includes wound care, occupational therapy and use of a nighttime splint for three to six months.

Appropriately selected patients can be treated with less invasive procedures that aim to disrupt the abnormal tissue enough to restore motion, without actual excision of the diseased tissue. This can be done mechanically (percutaneous fasciotomy/aponeurotomy) with a small needle or chemically (chemical fasciotomy) with injections of enzymes (proteins that break down the diseased tissue). Both procedures are done in clinic under local anesthesia. They are relatively painless, and rehabilitation is simpler. The main disadvantages are earlier recurrence and risk of injury to nerves, vessels and tendons. These procedures should therefore be performed by specialists, who will determine whether you are a suitable candidate.

Explore further: Ebola virus in Africa outbreak is a new strain

add to favorites email to friend print save as pdf

Related Stories

A pain-free window into painful neuropathies

Dec 05, 2007

Scientists have demonstrated a new technique for detecting a painful nerve condition known as neuropathy, which affects millions of people with diabetes and many other patients as well.

Advancement in tissue engineering promotes oral wound healing

Feb 03, 2009

Oral tissue engineering for transplantation to aid wound healing in mouth (oral cavity) reconstruction has taken a significant step forward with a Netherlands-based research team's successful development of a gum tissue (gingival) ...

Study uses bone marrow stem cells to regenerate skin

Jan 14, 2009

A new study suggests that adult bone marrow stem cells can be used in the construction of artificial skin. The findings mark an advancement in wound healing and may be used to pioneer a method of organ reconstruction. The ...

Recommended for you

Malaysia quarantines 64 villagers over MERS virus

1 hour ago

Malaysia has quarantined 64 people in a southern village after one of its residents become the country's first person to die of a respiratory illness that is spreading from the Middle East, local media reported Thursday.

Spate of Mideast virus infections raises concerns

1 hour ago

A recent spate of infections from a frequently deadly Middle East virus is raising new worries about efforts to contain the illness, with infectious disease experts urging greater vigilance in combatting ...

New MRSA superbug emerges in Brazil

2 hours ago

An international research team led by Cesar A. Arias, M.D., Ph.D., at The University of Texas Health Science Center at Houston (UTHealth) has identified a new superbug that caused a bloodstream infection ...

User comments : 0

More news stories

Turning off depression in the brain

Scientists have traced vulnerability to depression-like behaviors in mice to out-of-balance electrical activity inside neurons of the brain's reward circuit and experimentally reversed it – but there's ...

Is Parkinson's an autoimmune disease?

The cause of neuronal death in Parkinson's disease is still unknown, but a new study proposes that neurons may be mistaken for foreign invaders and killed by the person's own immune system, similar to the ...