What is Dupuytren's Disease?
Dupuytren's disease is the abnormal thickening of the connective tissue, known as fascia, just beneath the skin. This thickening occurs within the palm and can extend to the fingers. Hard cords and nodules can develop, causing the fingers to bend towards the palm, a condition known as Dupuytren's contracture. Although the skin can be directly involved in the process, deeper structures like tendons are not directly affected. Sometimes, the disease causes thickening above the finger joints (joint pads) or on the soles of the feet in the form of nodules or cords (plantar fibromatosis).
What Causes Dupuytren's Disease?
The cause of Dupuytren's disease is unknown, but it may be related to certain biochemical factors within the affected fascia. Dupuytren's disease is more common in men over the age of 40. There is no proven evidence that hand injuries or specific occupational exposures lead to a higher risk of developing Dupuytren's disease.
What are the Symptoms of Dupuytren's Disease?
The symptoms of Dupuytren's disease typically involve the formation of nodules and pits in the palm. The nodules are usually firm and adherent to the skin. Thick cords can develop, extending from the palm to one or more fingers, with the ring (4th finger) and little finger (5th finger) most commonly affected. These cords can be mistaken for tendons during a physical examination, but they actually extend between the skin and tendons. These cords cause the fingers to bend or contract. In most cases, both hands are affected, although the degree of involvement may vary.
Early in the disease, the initial nodules may cause transient discomfort that eventually resolves, but Dupuytren's disease is typically not painful. Patients often notice the disease when they are unable to place their hands flat on a surface like a tabletop. As the fingers are drawn into the palm, increasing difficulties develop in activities such as washing, wearing gloves, shaking hands, and putting hands in pockets. Progression is unpredictable. While some individuals may only have small nodules or cords, others may have severely bent fingers. More severe disease usually occurs at an earlier age.
What are the Treatment Options for Dupuytren's Disease?
In mild cases, particularly when hand function is not affected, monitoring alone may be sufficient. For more severe cases, there are various treatment options available to straighten the affected finger(s). These options include collagenase injection, percutaneous needle aponeurotomy, or open surgery.
Collagenase injection is a technique where a small amount of medication is injected into the Dupuytren's tissue. The injected medication weakens the Dupuytren's tissue, allowing it to be manually manipulated to straighten the finger.
Surgical Treatment for Dupuytren's Disease
Surgery for Dupuytren's contracture involves both cutting the cords and removing nodules, cords, and even diseased skin from the hand. This is called a fasciectomy.
An individualized surgical plan will be created for each patient. The surgery is performed under general or regional anesthesia. Hospitalization is not necessary, and patients can go home a few hours after the surgery. The skin is usually closed with sutures, but sometimes sections of the skin are left open to prevent recurrence of the nodules. Due to the cut surface area, some blood in the dressings during the first few dressing changes is normal. The correction movement (extension) of the hand and fingers is improved.
Following surgery, a splinting and physiotherapy process with a hand therapist is required. This is generally very beneficial in improving the function of the affected fingers. The recovery time for fasciectomy surgery is typically about 6 weeks. The hand can be used during this time. Patients will need to set aside time several times a day for exercises, wearing a splint, or attending therapy sessions.
