“Why is my hand curling up?”
This is a question posed to many hand surgeons and hand therapists. Sometimes, the answer is Dupuytren’s (du-pwe-TRANZ) disease, also referred to as ‘viking finger’ – is when the tissue under the skin near your 4th and 5th fingers becomes thicker and less flexible gradually over years. This condition usually begins with small nodules developing in the palm of the hand. Dupuytren’s contracture can manifest in severity over a broad scale, beginning with simple nodules and progressing toward full flexion contracture of the affected fingers. While the most prevalent risk factors are age, ancestry, and family history, other risk factors include alcohol and tobacco use, as well as diabetes. Smoking is associated with an increased risk of Dupuytren’s contracture, perhaps because of microscopic changes within blood vessels caused by smoking. People with diabetes are reported to have an increased risk of Dupuytren’s contracture, likely due to connective tissue changes. Photos below.
How does this look?
The condition affects a layer of connective tissue that lies under the skin of your palm – called fascia. Knots of tissue form under the skin — eventually creating a thick cord that pulls one or more fingers into a bent position, most often the two fingers farthest from the thumb. The affected fingers can’t be straightened completely, which can complicate everyday activities such as placing your hands in your pockets, putting on gloves, or even simply shaking hands.
What should I do?
There is no one correct answer. Some cases of Dupuytren’s disease do not progress past nodule formation. In those cases, if the nodules are not painful, no treatment is required. If the nodules progress to cords, or become painful, surgical intervention may be required. Certainly, if flexion contractures develop, limiting the extension of affected fingers, one should seek medical attention. In short, if the posture of your hand is limiting your ability to perform daily activities, help is available here.
Who should I consult?
If you’re unsure of your condition and would like guidance, Axes Physical Therapy hand therapists will perform a free screening to help diagnose and can connect you with the appropriate medical resources. Depending on the severity of your condition, we report our suspected concerns to your primary care physician, or if you have one, your hand surgery specialist. Upon further examination, they can then refer you to a hand surgeon to determine if surgery is indicated.
What are the treatments?
Dupuytren’s contracture can be treated several ways. Needle aponeurotomy (separating the connective tissue from the fingers) is one option that can usually be performed in the MD office for mild cases. Injectable medications are also used in conjunction with phased manual closed manipulation. The most aggressive form of intervention is surgical removal of the diseased palmar fascia. This procedure is usually performed in the operating room under general anesthesia. All of the aforementioned treatments may be accompanied by a referral to hand therapy to assist in regaining lost range of motion, proper scar modeling, and return to full use of the affected hand. The fabrication of a custom orthosis to be worn at night is the gold standard of care following intervention. An Axes Hand Therapist is trained in fabrication of these orthoses and will fit you with one on your first visit.
Can it come back?
Recurrence of Dupuytren’s is possible. Interventions and treatments are the same as the primary occurrence. The goal of all intervention is to increase the available range of motion in order to allow for effective grasp and release.
