What is Dupuytren’s Disease?
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.
Signs & Symptoms Of Dupuytren’s Disease
Dupuytren’s Disease progresses gradually over several years and typically starts with a firm lump in the palm, which may or may not cause discomfort. As time goes on, this lump can develop into a tough cord beneath the skin that extends into the finger. This cord can tighten, drawing the finger toward the palm, sometimes quite significantly. This condition usually impacts the two fingers that are farthest from the thumb and often occurs in both hands.
Causes of
Dupuytren’s Disease
Diagnosis of
Dupuytren’s Disease
Dupuytren contracture is typically diagnosed through a physical examination, as most cases can be identified by the appearance and texture of the hands. Our hand doctors will compare both hands and look for puckering of the skin on the palms. They also press on various areas of the hands and fingers to check for hard knots or bands of tissue. A common test involves asking the patient to place their palm flat on a surface; difficulty in fully flattening the fingers may indicate the need for treatment.
Treatment of
Dupuytren’s Disease
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 exercises, 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 undergo 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, as well as the person’s functional needs. Most treatments involve some form of dividing, removing, or dissolving the thickened tissue to untether the affected digits. This is typically done in an outpatient setting, often followed by therapy to restore motion and minimize recurrence.
Dupuytren’s Disease FAQ
Who is most likely to develop Dupuytren’s disease?
Individuals most likely to develop Dupuytren’s Disease include those over 50, particularly men, and those with a family history of the condition. It is also more common in people of Northern European descent and those with medical conditions such as diabetes or liver disease.
Can Dupuytren’s disease recur after treatment?
Yes, Dupuytren’s Disease can recur even after treatment, such as surgery or collagenase injections. Regular monitoring is important to address any changes or recurrence of symptoms over time.
What happens if Dupuytren’s disease goes untreated?
If left untreated, the fingers progressively bend and contract, leading to an inability to fully open the hand and a decrease in hand function. This can significantly impact daily activities and overall quality of life.