What is Dupuytren’s Disease?

Dupuytren's contracture or Dupuytren’s disease is a fairly common condition that causes one or more fingers to bend into the palm of the hand. The condition often occurs in later life, and although it affects men and women, it is most common in men who are aged over 40. Around one in six men over the age of 65 are affected in the UK.

The disease starts with the appearance of a lump or band in the palm of your hand, which develops over a period of time. This lump is usually painless, but can be tender when it is rapidly growing or on direct pressure. Over time the lump can develop into a band passing into the fingers leading to the finger contracture. When a contracture forms, fingers do not straighten up and you can get problems putting your hand in a pocket or putting on gloves.

This tissue is similar to scar tissue and becomes a problem when fingers cannot straighten. The condition can occur in other parts of the body and it’s known by other names:

• Soles of feet: Plantar fasciitis
• Penis: Peyronies disease
• Over the knuckles: Garrods pads

Risk factors

The most common cause is genetic, where it is inherited from one of your parents or grandparents, however, other factors can increase the risk or severity of the disease:

• Alcohol abuse
• Smoking
• Epilepsy medication
• Injury to the hand
• Diabetes

Treatment

There is no cure, however surgery can usually make bent fingers straighter, though not always fully straight; it cannot eradicate the disease. 

 Non-surgical treatment:

• Conservative treatment with a splint - there is some evidence that splints worn at night time (to keep the fingers straight) will help to prevent disease progression, however the success rate of treating the condition is very low and not helpful in people suffering from rapidly advancing Dupuytren’s
• Injections – a steroid injection into the painful lump in the palm has a 50% success rate in improving the symptoms, however this is short lived, does not prevent the disease progression and can be a very painful procedure

 Surgery

Depending on the stage of the disease, there are various procedure options:

• Needle aponeurotomy - this is the simplest form of treatment where, under local anaesthetic, the cords in the palm are released with a needle which allows the fingers to straighten up
• Segmental fasciectomy - this is usually reserved for more extensive disease in the palm and sometimes in the fingers. A section of the cord is excised under local anaesthetic as a day case procedure. There will be few stitches which need to be removed after 10-14 days
• Fasciectomy - this is the most common operation for Dupuytren’s contracture. This operation can be done under a general anaesthetic (you will be asleep) or regional anaesthesia (you will be awake but the operated hand is anaesthetised). During this operation the diseased area under the skin is removed as much as it is safely possible. Zig-zag incisions are used to reduce the risk of recurrence
• Dermofasciectomy - in very severe or advanced disease, the skin overlying the diseased finger is also involved and therefore, is removed during this procedure. The area where the skin has been removed, is then covered by a skin graft (usually taken from the same arm)
• Repeat operations - revision surgery is usually carried out for severe recurrence of the disease following the initial surgery. This is a longer and more extensive procedure that requires surgery to the affected joints. Skin graft may be necessary as the diseased skin following the recurrence is removed
• Joint fusion or amputation - these procedures are rare and considered as the last stage operation. They are reserved for severe joint contracture and a previously operated finger with severe recurrence of finger contracture

Miss Ladan Hajipour is an OrthTeam Consultant Orthopaedic Hand and Wrist Surgeon. Book a consultation with Ladan here, or for more information please call 0161 447 6888.