Palmar Fibromatosis (Dupuytren's contracture)

I’m unable to extend my finger due to a cord in my palm

If you have noticed, that one or more of your fingers are held in flexion by cords and nodules in your palm, you probably have Dupuytren’s contracture or palmar fibromatosis.

What is palmar fibromatosis (Dupuytren’s contracture)?

Palmar fibromatosis is a hereditary condition that transforms the fibrous tissue in the palm into cords and nodule. It is a progressive disease that can cause severe contracture to fingers and thumb and heavily compromises hand function.

What are the symptoms of palmar fibromatosis (Dupuytren’s contracture)?

The condition starts with thickening of tissue in the palm in line with a finger. In most cases a nodule forms at the base of the ring finger first. As the fibromatosis progresses a cord forms that crosses the first finger joint (metacarpo-phalangeal joint /MCPJ). This is when a visible contracture appears. Eventually the cord will reach from the palm across the MCPJ to the next joint which is called ‘proximal inter-phalangeal joint’ (PIPJ). If left untreated the finger will develop severe contracture where the tip can eventually touch the palm. Dupuytren’s contracture has various expressions and it ranges from a singular finger being involved to multiple fingers being affected. There can also be cords in the first web space reducing the grip span significantly.

Who gets palmar fibromatosis (Dupuytren’s contracture)?

Dupuytren’s contracture is a hereditary condition meaning it is determined in ones gene pool. It is unclear what triggers the onset as it can jump generations and not all family members evenly get it. There was thought to be correlation with diabetes mellitus and increased alcohol intake but that has not been proven. Basically if you can recall your grandparents or parents having the condition, you may or may not get it. There are no preventative measures.

How is palmar fibromatosis (Dupuytren’s contracture) diagnosed?

The clinical appearance is typical and if matched with a positive history, diagnosis is established. Ultrasound is able to image to thickened palmar tissues as well is MRI. However to make a diagnosis, the clinical picture will suffice.

Treatment for palmar fibromatosis (Dupuytren’s contracture)

Dupuytren’s contracture is a progressive disease that will compromise hand function if left untreated. Once the contracture has reached a point where the palm cannot be put flat on a table, management is indicated. Physical or hand therapy will not be able to influence the progression of the contracture. The only non-operative measure available is injection with Collagenase. This is a synthetically manufactured enzyme which weakens the cord. 48 hours following the injection the contracture can be mobilised which will break the cord and restore hand function. This procedure can be carried out in my practice rooms and does not require hospital admission or general anaesthesia. Hand therapy and night splints are required for a good long term result. However where multiple fingers are involved or the contracture is progressed too far, surgery is an option.

Important update regarding Collagenase injections (Xiaflex®) for Dupuytren’s contracture (palmar fibromatosis).

As of June 2019 Xiaflex® has been withdrawn and deregistered from the Australian market. The decision to discontinue sales and withdraw the Marketing Authorisation for Xiaflex® was not based on any safety or efficacy concerns.

Unfortunately since Xiaflex® was the only available Collagenase product I am unable to offer this treatment anymore.

If you are suffering from Dupuytren’s contracture (palmar fibromatosis), surgical palmar fasciectomy is the procedure of choice.

Surgery for palmar fibromatosis (Dupuytren’s contracture)

Surgery for palmar fibromatosis can be carried out as day surgery in some cases. In others however, where the contracture has progressed across multiple fingers, the procedure can take several hours and over night hospital stay is recommended. During the surgery the diseased and contracture producing issue will be removed. This can make an extensive incision and soft tissue dissection necessary. Sometimes joint releases are required too in order to overcome residual stiffness.

Preparing for surgery for palmar fibromatosis (Dupuytren’s contracture)

If required we will arrange for a bulk billed pre-admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and request investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details.

Recovery from surgery for palmar fibromatosis (Dupuytren’s contracture)

Regular hand therapy is mandatory following the procedure for wound care, night splints and most importantly stretches and exercises. The duration of this kind of follow up will depend on the extend of surgery. Night splints to keep fingers straight are recommended for 12 weeks. A review appointment with your surgeon will be scheduled for two and six weeks after surgery.