DUPUYTREN’S DISEASE
Introduction
Dupuytren’s disease is a genetically-based condition that typically affects people of northern European ancestry over the age of fifty. The condition causes a gradual thickening and contracting of the tissue of the palm and fingers, resulting in restriction of full extension.
The palm of the hand and fingers has a special layer of tissue just underneath the skin and fat known as the palmar fascia. The fascia provides extra stability needed for grasp. This layer is not present on the back of the hand, where the skin and fat are soft and loose. In Dupuytren’s disease, the fascia slowly begins to thicken and contract, often in the ring and small fingers. Initially, the only noticeable effect may be some thickening and lumpiness in the palm. Eventually, the contraction may progress to where it is difficult to fully straighten the fingers. Although initially the thickened areas may be tender, the condition is often painless. When the contracture becomes significant enough to warrant attention, difficulty with simple activities such as glove wear and placing the hand in a pant pocket become noticeable.
Treatment
In mild cases, where there is no significant restriction of motion, simple observation is usually the treatment of choice. There is no known way to halt the process either by medication, stretching exercise or bracing. The rate of progression is extremely variable from case to case. Some individuals may not require any intervention in their lifetime while others may have multiple procedures starting at an early age. As a general rule, if someone can still place their entire palm flat against a table, no intervention is usually required.
When the impact on hand function becomes unacceptable, active treatment is considered. The method of treatment is individually tailored depending on the location and severity of the contracture and the person’s functional needs. Most treatments involve some form dividing, removing or dissolving the thickened tissue to untether the affected digits. This is typically done is an outpatient setting, often followed by therapy to restore motion and minimize recurrence.