Dupuytren’s disease
Dupuytren’s disease (also referred to as Dupuytren’s contracture) is a common condition that usually arises in middle age or later. It is more common in men than women.
In the palm there is a layer of thin tissue called the palmar fascia. In Dupuytren’s disease there is a shortening and thickening of the palmar fascia. Firm nodules appear in the palm and in some cases this can progress which leads to the affected finger(s) bending towards the palm. It may then become difficult or impossible to straighten the finger completely.
Diagram 2: Palm Thickening from Dupuytren’s Disease
What causes Dupuytren’s disease?
Although the cause of Dupuytren’s disease is unknown it can often run in families but this is not always the case. It is common in Northern Europe and in populations with Viking descent and tends to affect more men than women, although women can develop the condition too.
Dupuytren’s disease is also associated with:
- Diabetes
- Smoking
- High alcohol consumption
- Previous hand or wrist injury
- Previous hand or wrist surgery
Many people affected have none of the above. Contrary to popular belief it does not appear to be associated with manual work.
Common Myths of Dupuytrens Disease
Myth 1: Dupuytren’s Disease is a painful condition.
Fact 1: Discomfort/mild pain may be present in the early/active stages but nearly always this improves/goes away with time.
Myth 2: I need an operation.
Fact 2: Not everyone will need an operation. Many people with mild Dupuytren’s disease continue to manage all of their everyday living activities with little/no problem. It is only when these activities become a real problem or the finger(s) is bent towards the palm in a troublesome manner that surgery is considered.
Myth 3 Steroid injections help/stop Dupuytren’s.
Fact 3 Steroid injection are not useful or beneficial in Dupuytren’s disease.
Myth 4 I can stop my Dupuytren’s from becoming worse.
Fact 4 You cannot stop or prevent Dupuytren’s disease. It is a disease that does its own thing. There some factors such as smoking and high alcohol consumption which can make your Dupuytren’s disease worse so making lifestyle changes can be helpful.
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What are the treatment options for Dupuytren’s Disease?
Option one – conservative management/do nothing (yes nothing is an option!)
If the condition is not particularly bothersome, it is quite safe to leave things as they are. Many people have fairly stable disease that does not change much over the years, and never seek help with the condition.
Option two – surgery
Surgery can usually make bent fingers straighter, though not always fully straight; it cannot eradicate the condition as there is no cure. Surgery is not needed if the finger can be fully straightened. Surgery is only considered if:
- It has become impossible to put the hand flat on a table.
- There is a contracture that is interfering with the function of your hand.
- Your condition is progressing in a relatively quick manner.
- There is recurrence of the condition that is interfering with hand function.
The surgeon can advise on the type of operation that is best suited and on its timing. Procedures may be carried out under local anaesthetic or general anaesthetic.
Surgical options are:
1. Fasciotomy
The contracted cord of Dupuytren’s disease is simply cut in the palm, in the finger or in both, using a small knife or a needle
2. Segmental fasciectomy
Short segments of the cord are removed through one or more small incisions
3. Regional fasciectomy
Through a single longer incision, the entire cord is removed.
4. Dermofasciectomy
The cord is removed together with the overlying skin and the skin is replaced with a graft that is usually taken from the upper arm. This procedure is usually undertaken for recurrent disease, or for extensive disease in a younger individual and helps to prevent recurrence.
What happens after surgery?
After surgery your hand may be fitted with a splint. This is to help maintain the corrected position of the finger(s). It is worn overnight and it is often recommended that this be worn for up to three months after surgery.
Hand therapy is important in helping to facilitate wound/scar healing and in recovering range of movement and function in the hand, especially for more extensive surgery and skin grafts. The recovery is variable with regard to wound healing, the degree of improvement achieved and the time to achieve the final position.
The final outcome is dependent on many factors including the extent and behaviour of the disease itself and the type of surgery required. The outcome is never guaranteed.
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