Dupytren's Contracture Symptoms
The symptoms of Dupuytren's contracture usually emerge gradually. The onset frequently is heralded by a small tender lump or nodule in the palm. Palmar skin may thicken (often mistaken for a callus). A layer of tissue just beneath the skin, the palmar aponeurosis, thickens and begins to contract. If some of the abnormal tissue attached to the underside of the skin contracts, a dimple forms. The contracting tissues often form into bands or cords attaching to the palm side of the fingers.
These cords often may be seen and felt. When very prominent, the cords are commonly mistaken for tendons. In the earliest contracture, a tethering action and restriction to straightening occurs. This can be detected by the "tabletop test". With the palm downward, pressed onto a flat surface, the fingers should be able to elevate individually from the surface. If any of the fingers cannot be so lifted, the test is "positive" and tethering or restriction is present; an early contracture has occurred.
As the contracture progresses, the fingers progressively lose their ability to straighten. With time and further progression of the contracture, the fingers may curl downward into the palm. Although any finger may be involved, those most commonly affected are the ring and little "pinky" fingers. In diabetics, the long finger is the most common.
When all or some of these conditions are present, holding a bar of soap, shaking hands, combing hair, applauding, using a keyboard, and other common actions become awkward or difficult.
There are two maladies commonly associated with Dupuytren's disease. Ledderhose disease, the formation of fibromas or nodules in the longitudinal arch of the foot, and Peyronie's disease wherein a fibrotic band occurs in the penis producing a curvature. The needle aponeurotomy is ineffective in treating these problems.