Dear Dr. Roach: I am a 73-year-old active lady. I recently noticed a wrinkle in my palm near my ring finger. I had a consultation with a nearby doctor, and he diagnosed Dupuytrens contracture. He said I should come back when the finger is curved down. I was surprised! Wouldnt it be better to have it taken care of before it gets to be a serious problem? I dont understand why I should put this off. Would surgery done promptly have a shorter recovery time? H.B.
Answer: Dupuytrens contracture is a condition of unknown cause characterized by progressive fibrosis of the deep connective tissue of the hand, called the palmar fascia. It often starts with a nodule in the hand, and progresses over years or decades to flexion of the finger joints a permanent curve toward the palm. It most commonly affects the fourth finger, and the joints on either side of that ring finger become difficult to straighten, then finally impossible to straighten completely. It is usually painless. The condition is most common in people of Northern European ancestry.
Because progression is variable in timing, and because people can have no bothersome symptoms for years (and the condition goes away in about 10%), there is no consensus on when the optimal time for intervention. Most experts recommend treatment when the degree of flexion is at least 20 degrees. A fixed bend of more than 60 degrees is less likely to respond to treatment.