Introduction
Dupuytren’s disease is a condition resulting in contractures in the palm and fingers as a result of thickening of the deep tissue of the palm (palmar fascia).
The palmar fascia is a layer of deep tissue which extends from the palm to the fingers. In patients with Dupuytren’s disease, this fascia thickens. Initially it forms small firm nodules under the skin. The nodules then coalesce to form cords which cause tethering of the skin and bending of the fingers. This is called a contracture.
The ring and little finger are most commonly affected. This condition most commonly affects males over 40 years of age from Northern European and Anglo-Saxon background.
Causes
The exact cause is not known in many cases. The disease can sometimes run in families, so there is a genetic component.
There are a number of risk factors including diabetes, smoking and alcohol use, but most patients do not have an obvious cause.
Signs and symptoms
Diagnosis is based on patient symptoms and examination findings. The condition is usually NOT painful.
Nodule and Cords
Initially nodules / lumps form in the palm. Over many years, these form long cords which can extend to the fingers.
Pits and Puckering
Pits and puckering in the skin of the palm may form in association with the nodules / lumps.
Finger Contracture
As the cords thicken and tighten, the fingers claw and are drawn into the palm.
Hand Clawing
As multiple fingers become clawed, it may be difficult to lay the palm of hand flat on a table. It may also give difficulty in using the hand such as shaking hands, washing hands and using hands for work.
Non-surgical treatment
The condition progresses slowly over many years and may not cause any problems with the use of the hand. In these cases, no specific treatment is required.
In patients, where the contractures cause problems, a number of surgical and non-surgical options are available.
Splint
These may be used at night to keep hand / fingers straight.
Hand exercises
Exercises aimed at improving and maintaining flexibility of the fingers can be undertaken.
Xiaflex Injection
Xiaflex is a medication which breaks down the thickened cord tissue and therefore straighten the finger. The injection is initially performed in the office and after a few days the finger is straightened.
The injection does not cure the disease but breaks down the cord and straightens the finger. The cord can sometimes recur.
Needling
This is can also be performed in the office under local anaesthetic. Multiple punctures are made in the cord in the palm to break it down. After needling, a period of hand therapy is required to maintain flexibility.
The needling does not cure the disease but breaks the cord down. The cord can recur after this procedure.