Dupuytren’s Disease

Dupuytren’s Disease

Dupuytren’s Disease Specialist in Houston, TX

The highly trained hand and wrist specialists at Hand Surgery Specialists of Texas specialize in diagnosing and treating Dupuytren’s disease. Call (713) 322-0054 to schedule an appointment at one of our offices in Houston, Baytown, or Katy, Texas.

What is Dupuytren’s Disease?

finger-evaluationDupuytren’s disease is a collagen disorder that afflicts around 5% of people of Northern European descent. It occurs when the layer of tissue just below the skin of the palm of the hand becomes abnormally thick and nodular. This thickening spreads into the fingers and causes the finger joints (primarily in the ring and little fingers) to contract and not extend easily or completely even with effort. Males are much more likely to have this condition – they account for 75% of patients, and the majority are over 40 years old.

Firm pits, nodules, and cords may cause the fingers to bend into the palm, a condition called Dupuytren’s contracture. The disease will also sometimes cause thickening on top of knuckles (the fingers’ knuckle pads).

Causes

In Dupuytren’s disease, the body mistakenly begins to produce thick type III collagen in place of the thinner, more pliant type I collagen of the normal palm. The reason this mistake occurs is not clear, but heredity, a variety of behaviors such as smoking and excessive alcohol intake, and diseases like diabetes are correlated with higher risk. The thickened fascia in afflicted men has a high count of androgen receptors, which correlates with the higher proportion of men who develop Dupuytren’s disease and their more severe symptoms.

There is no evidence that hand injuries or repetitive behaviors increase the risk of developing Dupuytren’s disease.

There is no known cause of Dupuytren’s contracture, though the condition is often seen in individuals who:

  • Are over the age of 50
  • Use tobacco products
  • Are male
  • Have a family history of Dupuytren’s contracture
  • Frequently consume alcohol
  • Are of Northern European descent
  • Have diabetes

Signs & Symptoms

Dupuytren’s disease presents with firm lumps and pits within the palm. Thick cords sometimes develop, stretching from the palm into one or more fingers, generally the ring and little fingers, causing bending of the fingers. In many cases, both hands are affected, though it is sometimes just one.

Though initial lumps may be uncomfortable, Dupuytren’s disease is not typically painful. Early presentations may be noticed because it is challenging to place a hand flat on an even surface, such as a table, or putting hands into pockets. Some patients progress dramatically, and some only ever grow minimal lumps or cords. It’s generally thought that the earlier the age of onset with Dupuytren’s disease, the more severe the disease will progress.

  • Firm lumps or nodules in the palm of the hand (first stage)
  • Involuntary contraction of the fingers, primarily the ring and little finger (later stage)
  • One hand or both
  • Reduces flexibility and hand use, but not typically painful

Diagnosis & Treatment

Because it creates a non-reversible change in the nature of new tissue production in the hand, Dupuytren’s disease cannot be cured. Especially in mild cases, when hand function is not affected, treatment may not be recommended.

In more severe cases, different options can help straighten affected finger(s). We can discuss the method optimal suited for your condition based on the stage and pattern of the disease and the joints involved. Even if treatment successfully straightens affected finger(s), the disease process may recur.

Our hand surgeons can often provide effective relief of symptoms through treatment to make the hand more pliable. These treatment options include the following:

Collagenase

Collagenase is an injectable medication used to dissolve the nodule and some of the thickened tissues.

Needle Aponevrotomy

This particular treatment uses fine needles that are inserted into the hand to help break apart thickened tissues that cause the person’s hand to contract involuntarily. The entire process is absolutely painless, as a topical anesthetic is applied by your hand specialist beforehand to help numb the area.

Needle aponeurotomy, also called needling, is not a permanent solution, and treatments will typically need to be ongoing to help continually relieve the individual’s symptoms of Dupuytren’s contracture.

Corticosteroids have often been used to reduce swelling and inflammation from painful nodules of the hand. These injections can help to slow the developmental process of Dupuytren’s contracture, though it will not be able to reverse the effects of the condition.

In more recent years, enzyme injections have been approved by the FDA for treatment of Dupuytren’s contracture. This enzyme is specially designed to break apart the tough, fibrous cords that are commonly associated with cases of Dupuytren’s contracture. As the enzyme begins to take effect, your physician will begin to gently stretch the tendons of contracted fingers to hopefully restore their full flexibility and mobility.

Splinting

Another way to stretch the tendons of fingers affected by Dupuytren’s contracture is to regularly wear a splint that forces the fingers to be fully extended. Patients considering splinting should approach this treatment with caution, and should not begin using a splint until it is approved by your hand surgery specialist, as forceful manipulation of the fingers can lead to further injury if not administered properly.

Surgical Treatment in Houston, TX

Surgery is often recommended for individuals with a severe instance of Dupuytren’s contracture, or for those who have not gained satisfactory results from less invasive treatment options. These types of surgical procedures usually require a significant amount of recovery time, though surgery is still much more suitable for patients who require more immediate and long-lasting relief from their finger contractions.

Recovery

With any treatment path, recovery is considered around a week, though splinting (potentially only at night) will be advised for at least three months.

Physical therapy is rarely required.

To learn more about the hand surgery specialties of Hand Surgery Specialists of Texas, please call (713) 322-0054 to schedule a consultation with one of our experienced physicians today! 

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