Dupuytren’s disease is a condition that affects the hands. It is usually a non-painful condition that results in firm pits and nodules in the palm and tight bands extending up the finger causing the fingers to bend into the palm.
The cause of Dupuytren’s is largely unknown but there is a strong genetic predisposition. Dupuytren’s is also more common in males over 40.
Signs and Symptoms
The disease is an abnormal thickening of the tissue (also called the fascia) just under the skin. Patient’s normally notice firm nodules in the palm. Initially these can be uncomfortable but this usually resolves. Thick cords can develop and extend into the fingers. The most common fingers involved are the ring and little finger. Over time, the cords can contract, bending the fingers into the palm. It commonly affects both hands, but may present in one hand alone. Patients may notice that the have difficulty putting their hand flat on the table. Other common problems include difficulty wearing gloves, placing hands in pockets, washing the face and shaking hands.
It is impossible to predict how quickly the disease will progress. Some patients only ever have nodules in the palm and never progress to contracted fingers.
The disease cannot be cured, so the aim of treatment is to improve the use of the hand. In general, your surgeon will only recommend surgery if there is a bend in the finger which prevents you from doing normal activities.
- Needle aponeurotomy: this is where a needle is placed through the skin at multiple sites over the cord and used to lightly cut through the cord.
- Xiaflex injections (collagenase histolyticum): A small amount of medicine is injected into the Dupuytren’s cord which is causing the finger to bend. The medicine dissolves the diseased tissue allowing the surgeon to manipulate and straighten the finger after a few days.
- Open Surgery (Fasciectomy): Your surgeon will cut out the diseased tissue from the palm and fingers in the operating theatre of a hospital.
Not every treatment is suitable for all patients. Your surgeon will examine your hand, discuss all of the appropriate options, and then make a recommendation specific to your hands.
- Surgery is not always required for Dupuytren’s disease.
- Not every treatment option may be suitable for your hands. Your treating surgeon will recommend the best option for you.
- Dupuytren’s disease can not be cured. Even with surgery, there is a chance the disease in the hand will come back.
- Treatment will not always result in complete straightening of the fingers. The more severe the disease, and the greater the contractures of the fingers, the less likely the fingers can be made to be completely straight.
- Skin grafts may be required to cover areas of the hand.
- Hand Therapy and splinting is absolutely essential to achieve the best result after treatment.