A condition that affects the fascia – the thick fibrous layer of tissue that lies just underneath the skin. In patients with Dupuytren’s, 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 pulled inward, towards the palm, resulting in a “Dupuytren’s Contracture.”
The cause of Dupuytren’s disease is unknown; however, there is a strong hereditary component. 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.
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). These include needles, injectable medicine, or surgery. Unfortunately, conservative treatments such as bracing and therapy have not been shown effective in treating these more severe cases.
The goal of treatment is to improve finger motion and hand function; however, complete correction may not always happen. In addition, even with treatment, the disease may also come back.
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.