What is Dupuytren's Disease?

A condition that affects the fascia – the thick fibrous layer of tissue that lies just underneath the skin.  In patients with Dupuytren’s disease, the fascia in the palm thickens, and can tighten over time causing pits, nodules, or cords (thick lines) to develop. This can cause the fingers to pull inward, towards the palm, resulting in a “Dupuytren’s Contracture.”

What causes Dupuytren’s Disease?

The cause of Dupuytren’s disease is unknown; however, important factors include genetics, ethnicity, sex, and age and may include certain environmental factors and other diseases. It is more common in men over age 40 and people of northern European descent.  The nodules can be uncomfortable in some people, but Dupuytren’s contracture is not typically painful.

The disease is often first noticed by the thickened nodules, but this does not usually affect function.  The severity of disease and its progression is variable.  Some people will have only small lumps or cords, while others will develop a severely bent finger.  It is difficult to predict how the disease will progress.  Most times progression is noted by the inability to lay the hand flat on a table.  As the fingers draw into the palm, it may be more difficult to wear gloves, shake hands, and get hands into pockets.

How Is Dupuytren’s Disease Diagnosed?

The diagnosis is clinical.  Family and medical history, along with physical examination are usually sufficient to diagnose Dupuytren’s disease.  Radiographs may be taken to evaluate the bones and joints for other associated pathology that affects treatment, such as arthritis.
Dupuytren’s Disease

How Are Dupuytren’s Contractures Treated?

With good hand motion and function, mild cases require just observation.  A lump or pit in the palm does not mean treatment is needed, or that the disease will progress to a contracture. In more severe cases, such as when you are unable to lay the hand flat, various treatment options are available to straighten the finger(s).

  • Steroid injections

    This treatment helps the sufferer deal with inflammation and the pain that comes with it.

  • Enzyme injections

    Enzyme injections into the taut cord in your palm can soften and weaken the tissue. This gives the doctor an opportunity to break-up the cord and return the fingers to a more natural position.

  • Needle aponeurotomy

    In this technique, the objective is to break-up the affected cord of tissue with a needle. It’s a simple procedure that can be performed in the doctor’s office. However, it may not be an appropriate option for tissue close to certain nerves or tendons.

  • Surgery

    Patients with advanced Duputren’s contractures may require surgery to remove all tissue susceptible to Dupuytren's contracture, including the skin. This option lasts longer than needling or enzyme injections. However, it is the most invasive option, may require a skin graft, and intensive physical therapy as part of the recovery.

The goal of treatment is to improve finger motion and hand function.  In addition, even with treatment, the disease may return. Not everyone is a candidate for each treatment method, and the most appropriate method is based upon the stage and pattern of disease and the joints involved.  This, along with realistic goals and risks are discussed prior to any treatment.