“We don’t know the exact cause of Dupuytren’s contracture, but we do know there is some genetic component because the condition clusters in families," says Peter J. Evans, MD, PhD, an orthopedic surgeon and director of the Upper Extremity Center at the Cleveland Clinic in Ohio. “It’s common in northern Europeans and rare in Asians and African-Americans.” However, many people who have a mild and painless form of the disease are never diagnosed. A 2011 study published in the medical journal Hand used an Internet survey to see how common Dupuytren’s contraction is in the United States. Of the 23,103 people who responded, only about 1 percent had been diagnosed or treated. However, when asked about the typical characteristics of hand deformity, more than 7 percent reported signs that could be Dupuytren’s contracture. Risk factors that have been linked to this hand problem include:
Sex. Being a man greatly increases your risk for Dupuytren’s contracture. A 2009 review of 49 studies on Dupuytren’s contracture found that men were about six times more likely to have the disease than women were. In the 2011 Internet survey, 63 percent of the responders who had been diagnosed with Dupuytren’s contracture were men.Age. Dupuytren’s contracture increases with age. In the Internet study, the mean age of responders with a diagnosis of the condition was 59. According to the British Dupuytren’s Society, almost 80 percent of people with this hand problem are between 40 and 70.Family history. As mentioned, having Scandinavian or other northern European ancestry increases your risk. Studies done in Norway have shown that 30 percent of people older than 60 have Dupuytren’s. In the American Internet study, 18 percent of people who were diagnosed with Dupuytren’s contracture reported an immediate family member with symptoms of the condition.Diabetes. A 2011 review of Dupuytren’s contracture and diabetes published in the medical journal Endocrinology Studies found that diabetes increases the risk for the condition and that the longer you have diabetes, the higher the risk. An average of all studies shows that the risk of Dupuytren’s contracture with diabetes is about 20 percent. “This isn’t surprising because having diabetes can make any other condition worse,” Dr. Evans says. “In Dupuytren’s contracture, the connection is probably due to decreased blood supply to the hand fascia.“Seizure medication. Many studies over the years have found a link between diabetes and epilepsy, and it was once thought that having a seizure disorder was a risk factor for Dupuytren’s contracture. More recently this link has been narrowed down to certain medications taken for seizures — most commonly phenobarbital. Why this is the case isn’t yet understood.Smoking and drinking. Both alcohol and smoking are frequently mentioned as risk factors for Dupuytren’s contracture. “The evidence for smoking is stronger than for drinking, and it makes sense because smoking, like diabetes, decreases blood supply to the hand,” Evans says.
Hand injury and occupations that cause excessive hand wear and tear are frequently mentioned as risk factors, but they don’t cause the condition. “Trauma doesn’t cause Dupuytren’s contracture, but it may make the condition worse and speed up the development of hand deformity,” Evans says. Recognizing Dupuytren’s Contracture: When to Call Your Doctor Dupuytren’s contracture can take many years to develop. Some people have a mild form of the condition that never progresses to a severe hand deformity, and they may not need treatment, although they should still be monitored. However, if you do start to develop the hand deformity, early treatment works best. Signs and symptoms of Dupuytren’s contracture may occur in one or both hands. The most common fingers involved are the last two (the ring and pinky fingers), but any or all fingers can be affected. However, it’s rare that the thumb and index (pointer) finger are involved. Early signs that you should see your doctor include tender lumps or nodules in the palm of your hand; or painless lumps, pits, or cords of tissue in the palm. Signs that Dupuytren’s contracture may be progressing include curling of the fingers into the palm, inability to extend them, and increasing difficulty wearing gloves, shaking hands, and using the pockets in your clothes. “The course of Dupuytren’s contracture is unpredictable,” Evans says. “Stretching or splinting of the hand doesn’t help and may make things worse.” If you have signs or symptoms of Dupuytren’s contracture and you can’t place your hand flat on a table, see your doctor.
