Dupuytren's Contracture

Dupuytren’s contracture is a condition in which the tissue just beneath the skin of the palm gradually thickens and tightens, drawing one or more fingers down towards the palm so that they can no longer be fully straightened. It is usually slow and painless, and tends to affect the ring and little fingers most often. It is more common in men, becomes more likely with age, and frequently runs in families.

What happens in the hand

Beneath the skin of the palm lies a thin sheet of connective tissue called the palmar fascia. In Dupuytren’s, this tissue develops firm nodules and then cords that run along the palm and into the fingers. As a cord matures it shortens, and it is this shortening that bends the finger. Many people first notice a small firm lump in the palm; over months or years a cord may form and the finger begin to curl. The rate of progression varies widely — some hands change very little over a long period, while others tighten more quickly.

When treatment is considered

Not every Dupuytren’s hand needs an operation. Treatment is usually considered once a finger can no longer be laid flat — a simple check is whether the hand can be placed flat on a tabletop — or when a bent finger has begun to interfere with everyday use of the hand. Because the condition is progressive, the timing is a matter of judgement, weighed at the consultation against how much the hand is affected and how quickly it is changing. Surgery corrects the deformity that is present; it does not remove the underlying tendency, which is why the condition can return over time.

The treatment options

Several approaches exist, and which one suits a particular hand depends on the pattern and severity of the disease, the joints involved and any previous treatment. They range from dividing a cord through the skin with a needle, a less invasive option suited to a straightforward cord, to removing the diseased tissue through an incision in the palm — a fasciectomy, the most commonly performed operation, which addresses more established or complex disease. In severe or recurrent cases the affected skin over the cord may also be removed and replaced with a skin graft. Dr. Papavasiliou assesses the hand and advises which option is appropriate.

What the operation involves

A fasciectomy is usually carried out as a day case under a regional or general anaesthetic. Through carefully planned incisions in the palm and finger, the diseased cords and nodules are removed, while the nerves and blood vessels that run alongside them — which the disease distorts and displaces — are identified and protected. The finger is straightened as far as the tissues safely allow, and the wounds are closed, sometimes with the skin rearranged to release tension along the finger. The hand is dressed and often supported in a splint.

Recovery

Hand therapy is central to the result. A splint is usually worn, frequently at night, for a period after surgery, and a programme of exercises begins early to keep the finger moving and to limit stiffness. Swelling and some discomfort are normal in the first weeks, and the palm can take time to heal fully. Most people return to light use of the hand within a couple of weeks, with a fuller recovery over the following months as movement and strength return. The final range of movement depends on how advanced the contracture was and on the joints involved.

Who it suits

Surgery suits people whose finger can no longer be straightened enough to use the hand comfortably. Two things are important to understand: a joint that has been bent for a long time may not fully straighten even after the cord is removed, and Dupuytren’s can recur over the years because the underlying tendency remains. These points, and what is realistic for a particular hand, are discussed in full at the consultation.

Where the surgery takes place

Dr. Papavasiliou assesses and treats Dupuytren’s contracture at EIPS in Nicosia and Limassol.