What Is Dupuytren’s Disease?
Dupuytren’s disease is an abnormal thickening of the fascia (the tissue just beneath the skin of the palm). It often starts with firm lumps in the palm. In some patients, firm cords will develop beneath the skin, stretching from the palm into the fingers. Gradually, these cords may cause the fingers to bend into the palm. 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).
The cause of Dupuytren’s disease is unknown but may be associated with certain biochemical factors within the involved fascia, which are likely influenced by genetic and environmental factors. The problem is more common in men over age 40 and 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.
Symptoms
Symptoms of Dupuytren’s disease usually include a small lump or series of lumps and pits within the palm. The lumps are generally firm and adherent to the skin. Gradually, a cord 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. Both hands are affected in many cases, 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. As the fingers are drawn into the palm, one may notice increasing difficulty with 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 at an earlier age of onset.
Diagnosis
Your physician will assess your symptoms. Patients often present with gradually worsening flexion contractures.
Treatment
In some cases, only observation is needed for nodules and cords that are not contracted. Patients with more advanced contractures may require surgery to improve function.
Various surgical techniques are available to correct finger position. Your treating surgeon will discuss the method most appropriate for your condition based on 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, and the fingers may bend into the palm again. Before surgery, your treating surgeon will discuss realistic goals and results, including the following:
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 finger's base. Sometimes, complete correction cannot be attained, especially for 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 to maximize and maintain improvement in finger position and function.
Recently, collagenase injections and percutaneous procedures have been utilized to treat certain patients with Dupuytren’s contractures. These procedures have yielded promising results in patients with a discretely palpable cord causing a contracture. The advantages of these less invasive procedures include minimal pain and virtually no rehabilitation or time away from work.