What is Dupuytren's disease?
Dupuytren’s disease is an abnormal thickening of the tissue just beneath the
skin known as fascia. This thickening occurs in the palm and can extend into
the fingers (see Figure 1). Firm cords and lumps may develop that can cause
the fingers to bend into the palm (see Figure 2), in which case it is
described as Dupuytren’s contracture. Although the skin may become involved
in the process, the deeper structures—such as the tendons—are not directly
involved. Occasionally, the disease will cause thickening on top of the
finger knuckles (knuckle pads), or nodules or cords within the soles of the
feet (plantar fibromatosis).
What causes Dupuytren's disease?
The cause of Dupuytren’s disease is unknown but may be associated
with certain biochemical factors within the involved fascia. The problem is
more common in men over age 40 and in people of northern European descent.
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 and signs of Dupuytren's disease?
Symptoms of Dupuytren’s disease usually include lumps and pits within the
palm. The lumps are generally firm and adherent to the skin. Thick cords may
develop, extending from the palm into one or more fingers, with the ring and
little fingers most commonly affected. These cords may be mistaken for
tendons, but they actually lie between the skin and the tendons. These cords
cause bending or contractures of the fingers. In many cases, both hands are
affected, although the degree of involvement may vary.
The initial nodules may produce discomfort that usually resolves, but
Dupuytren’s disease is not typically painful. The disease may first be
noticed because of difficulty placing the hand flat on an even surface, such
as a tabletop (see Figure 3). As the fingers are drawn into the palm, one
may notice increasing difficulty with activities such as washing, wearing
gloves, shaking hands, and putting hands into pockets. Progression is
unpredictable. Some individuals will have only small lumps or cords while
others will develop severely bent fingers. More severe disease often occurs
with an earlier age of onset.
What are the treatment options
for Dupuytren's disease?
In mild cases especially if hand function is not affected, only observation
is needed. For more severe cases various surgical techniques are available
in order to straighten the finger(s). Your treating surgeon will discuss the
method most appropriate for your condition based upon the stage of the
disease and the joints involved. The goal of surgery is to improve finger
position and thereby hand function. Despite surgery, the disease process may
recur. Before surgery, your treating surgeon will discuss realistic goals
and results. Types of surgery may include Needle Aponeurotomy, Partial or
Complete Fasciectomy, and limited release as well as on occasion injection
in a nodule. The rationale behind each treatment depends upon the
treating physician and the patient.
Specific surgical considerations:
- The presence of a lump in the palm does not mean that surgery is
required or that the disease will progress.
- Correction of finger position is best accomplished with milder
contractures and contractures that affect the base of the finger.
Complete correction sometimes can not be attained, especially of the
middle and end joints in the finger.
- Skin grafts are sometimes required to cover open areas in the
fingers if the skin is deficient.
- The nerves that provide feeling to the fingertips are often
intertwined with the cords.
- Splinting and hand therapy are often required after surgery in order
to maximize and maintain the improvement in finger position and
function.
Figure 1: Dupuytrens disease may present as a small
lump, pit, or thickened cord in the palm of the hand
Figure 2: In advanced cases, a cord may extend into the
finger and bend it into the palm
More information
Dupuytren's Bibliography
Dupuytrens.pdf
portions © 2009 American Society for Surgery of the Hand. Developed by
the ASSH Public Education Committee
taken modified from ASSH by
www.handctr.com
