DUPUYTREN’S DISEASE

Dupuytren’s disease is a condition that affects the hands and fingers. It causes one or more fingers to bend into the palm of the hand. It can affect one or both hands, and sometimes affect the thumb.

Dupuytren’s disease involves the tissue underlying the palmar skin. The disease starts with small hard lumps or “nodules” in the palm from thickening of the tissue. The skin over the nodule may appear to be bunched or creased. Nodule may be tender in early stages. As the disease progresses, “cords” appear and gradually pull the fingers into the palm over a period of several months. While it is always possible to close the fingers into a fist the loss of ability to straighten the fingers can be annoying or quite disabling if multiple fingers are involved.

CAUSES

The exact cause of Dupuytren’s contracture is unknown, but it is a genetic disorder and runs in the family. If you have the gene that causes Dupuytren’s contracture, other factors such as diabetes, smoking, excessive alcohol consumption and certain medications may activate the condition.

WHO’S AFFECTED

Dupuytren’s contracture is fairly common. It can affect both sexes, but affects men more than women. The condition usually occurs during later life.  Most cases occur in men over 50 and women over 60.

The condition seems to be more common in people of North European descent. It’s thought the gene associated with the condition was brought to the UK by the Vikings.

TREATMENT

Many cases of Dupuytren’s contracture are mild and don’t need treatment. Treatment may be helpful if the condition is interfering with the normal functioning of your hand.

NON-SURGICAL TREATMENT

Non-surgical treatments include injections with a medication called Collagenase. A tiny amount of the medication is injected directly into the cord that is causing the finger to be bent. The finger is gently straightened 2 days later after injection under local anaesthetic. While the finger is straightened with this treatment, areas of thickened tissue remain. Movement and function in the hand usually returns quicker than surgery.

SURGICAL TREATMENT

In more severe cases, surgery can help to restore hand function. During surgery the diseased tissue is removed (fasciectomy) to allow the finger to return to a straight position. Recovery from surgery can take several weeks.

SUCCESS OF TREATMENT

Surgery or injection for Dupuytren’s contracture cannot always fully straighten the affected finger and unfortunately the problem can come back due to the underlying disease.

Undergoing surgery in the early stages by removing the nodule does not stop the condition from progressing and it is better to wait until a contracture develops that interferes with use of the hand.