Dupuytren's Disease

Dupuytren's Disease (also called Dupuytren's Contracture) is an inherited disorder, usually in Caucasian males, that causes a contracture in the hands (and at times, feet). It is sometimes confused with "trigger finger," which is a different condition, characterized by active popping/triggering of the finger/thumb.

What You Need To Know About Dupuytren's Disease

What is Dupuytren's Disease?

Dupuytren's disease is a condition where the cords and nodules of the palmar fascia are thickened and shortened on the palm of the hand. The condition does not involve the tendons or underlying bones. The thickened fascia may cause lumps to form under the skin and curl one or more fingers towards the palm.

The affected fingers cannot comfortably straighten, which can complicate daily life and impede hand functionality. As the condition worsens, fingers may become permanently bent in a fixed position and affect your ability to write, grasp objects, or move your fingers.

What is Dupuytren's Diathesis?

Dupuytren's diathesis is a more advanced form of Dupuytren's contracture. The condition affects both hands, and it is largely hereditary. The disease is associated with other common fascia conditions, including contractures in the feet (Ledderhose's disease) and curvature of the penis (Peyronie's disease).

What Causes Dupuytren's Disease?

The exact cause of Dupuytren's disease is unknown. It most commonly affects white males of Northern European and Scandinavian descent over the age of 60. It is more prevalent in patients with diabetes. Smoking, lung disease, alcoholism, and anticonvulsant medication are associated with Dupuytren's disease, but the relationship is unclear. Trauma to the hand may also play a role in its development. The condition may worsen due to injury or open wounds on the patient's hands.

Symptoms of Dupuytren's Disease

Dupuytren's disease often slowly progresses over several years, and the severity of symptoms can differ from patient to patient. It begins with a significant thickening of the skin on the palm. As the disease progresses, the skin on the palm may appear puckered as firm lumps of tissue form on the palm. The nodes may be sensitive but not painful, but eventually, cords of tissue from your palm will extend to your fingers.

As the cord contracts, affected fingers will tighten and curl. Typically, the two pinky and index fingers are most commonly compromised. The thickened nodules will contribute to the formation of tough cords. As the tissue under the skin contracts, your fingers will bend towards the palm. Afflicted patients will have trouble straightening their fingers and lose flexibility in their hands.

How is Dupuytren's Disease Diagnosed?

A doctor can typically diagnose Dupuytren's contracture when evaluating the look and feel of a patient's hands. The physician will check for puckering on the skin of the patient's palms and try to feel if tough knots of tissue bands are present. During a table-top test, a doctor may ask the patient to flatten their hand on a flat surface to test the hand's mobility. If the patient's hand cannot flatten on the table, your doctor may recommend surgery for the contractures.

Dupuytren's Contracture Treatment Options

There is no way to cure or prevent Dupuytren's disease, but there are several ways to relieve severe finger contracture. Fortunately, many patients may not encounter debilitating symptoms from Dupuytren's disease for years, and their condition may never progress past lump development in the palms. If the disease progresses to a severe point, a physician may recommend several non-surgical or surgical treatment options.

Non-Surgical Treatment

Physicians can treat early cases with local steroid injections. Additionally, affected tissue can now be injected and dissolved with enzyme injections. An injection of an enzyme called collagenase can help weaken the contracted cords to help break them up.

Needle Aponeurotomy is another option. It is a procedure done with a local anesthetic, where the surgeon breaks up affected tissue with a needle. There are no stitches/sutures with this technique. A physician may also recommend splinting to help prevent the progression of finger contracture. This forceful stretching of contracted fingers may help reduce the risk of recurrent contracture.

Surgical Treatment

Patients suffering from severe Dupuytren's disease may require surgical excision of the thickened fascial tissue or treatment to release the contracture. A physician may perform a limited palmar fasciectomy and remove the affected tissue. The hand is immobilized for 5-7 days after surgery.

Post-operatively formal hand therapy is usually required. There is always the possibility of the conditioning reoccurring or affected other fingers/thumbs after any treatment option. The outpatient surgery usually has longer-lasting release compared to steroid injections or needle aponeurotomy.

Learn more about common hand and wrist conditions at Resurgens Orthopaedics.