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Dupuytren’s Disease

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What is Dupuytren’s Disease

Dupuytren’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.

Sign & 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 best 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: an injectable medication used to dissolve the nodule and some of the thickened tissues.

Needle Aponevrotomy: a minimally invasive procedure in which a small needle, inserted into the palm, is used to release the thickened cords and restore finger movement.

 

Recovery

With either 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.

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