Understanding Dupuytrens Disease
What is Dupuytren’s Disease?
Also known as Dupuytren’s contracture, this condition involves the thickening of tissue beneath the skin of the hand, called the palmar fascia. This tough layer lies under the skin and fatty tissue in the palm, attaching the skin to the underlying skeleton to ensure stability. While the skin on most of the body remains mobile, the palm is uniquely structured to support a firm grip.
In the early stages, Dupuytren’s disease presents as firm nodules in the palm. Over time, however, the condition progresses, leading to finger contractures that make it difficult to straighten the joints. This happens because scar-like tissue forms within the fascia, and as this scar tissue matures, it contracts, drawing the fingers toward the palm. In severe cases, this contracture can impair hand function, although grip strength is typically preserved.
A thick cord forms in the palm and starts to pull the finger down
As the disease develops, the fingers are drawn further towards the palm
Causes and Risk Factors
Dupuytren’s disease is thought to be a genetic condition, commonly seen in people of Northern European descent, particularly those with Viking ancestry. Although many with the condition have a family history of it, this is not always the case. Other factors may increase the risk, including diabetes, smoking, heavy alcohol use, or prior hand trauma. Some studies suggest that people in manual labour or occupations involving significant vibration exposure may have a higher likelihood of developing this condition.
Symptoms and Progression
The initial sign of Dupuytren’s disease is often a small lump or nodule in the palm, sometimes accompanied by “pits” where parts of the skin pull inward. As the disease progresses, a cord may develop, though it is often mistaken for a tendon (which is not involved). In moderate to advanced cases, this cord can extend into the fingers, creating visible lumps and affecting the thumb or multiple fingers.
Can Dupuytren’s Disease Appear Elsewhere?
Yes, similar formations can appear in other parts of the body:
- Feet: Known as Ledderhose disease, this condition creates lumps under the arch of the foot.
- Knuckles: Called Garrod’s pads, it involves thickening over the knuckles.
- Penis: In men, a similar contracture can cause Peyronie’s disease.
When to Consider Treatment
Dupuytren’s disease is generally not serious and is not cancerous. Although it affects millions of people, only a small percentage require surgical intervention. If the contracture does not interfere with daily activities, treatment may not be necessary. However, if the contracture restricts movement, making it difficult to use tools, wear gloves, or perform other tasks, consulting a specialist may be beneficial.
Treatment Options
1. Conservative Management
- Observation: Many people experience slow disease progression, and their condition may remain stable without intervention.
- Stretching: Gentle stretching of the hands can be done, though evidence of effectiveness in preventing contracture is limited.
2. Surgical and Procedural Options
- Needle Fasciotomy: This minimally invasive procedure divides the Dupuytren’s cord with a needle. It is performed under local anaesthesia, suitable if the cord is restricted to the palm. Recovery is quick, with a high rate of patient satisfaction within the first year.
- Open Fasciotomy: Done under local or general anaesthesia, this procedure involves making an incision in the palm or fingers to release contractures. The wound may be left open to heal, typically over four weeks.
- Open Fasciectomy: This surgery removes the entire cord, commonly performed under regional or general anaesthesia. Part of the wound may be left open, requiring several weeks to heal.
- Dermofasciectomy: Recommended for recurrent or extensive disease in younger patients, this procedure removes both the cord and overlying skin, which is replaced with a skin graft (typically from the forearm). Recovery involves a plaster cast and about four weeks for healing.
- Amputation: In very severe or recurrent cases, finger amputation may be considered, but this is uncommon and only discussed after careful consultation.
3. Alternative Treatments
- Steroid Injections: These may relieve local tenderness but have little effect on disease progression.
- Xiapex injection: This drug has now been withdrawn from the market.
- Radiotherapy: An experimental treatment option in some research centres, though not commonly available in Scotland.
Postoperative Care
Most patients can return home the same day after surgery. Early movement is essential, and additional support from a team of hand therapists is recommended for wound care and functional recovery.
Summary
Dupuytren’s disease, while often mild, can cause progressive hand contractures in some individuals. A range of treatments is available depending on severity, from conservative management to surgical interventions. Consulting with a specialist can help determine the most appropriate course of action based on individual symptoms and lifestyle.
