You will have noticed a lump or band in the palm of your hand developing over the past months to years. Some people will have noticed nothing else but some patients will notice that the band extends into one or more fingers and the fingers will not straighten fully. The lump or band is the Dupuytren’s tissue and the bending of the fingers is due to this band getting shorter.
- Soles of feet – Ledderhose Disease (plantar fibromatosis)
- Penis – Peyronie's disease
- Over the knuckles – Garrod's pads
We know that the commonest reason for getting Dupuytren’s is
- Genetic – you are born with the tendency to develop the problem. The greater your tendency then the earlier you will develop it and the more severe it will be. However, other things can increase your risk or make the disease worse:
- Alcohol abuse
- Taking medication for epilepsy
- In other diseases such as Diabetes people develop a type of Dupuytren’s but it tends to be less severe.
The first thing most people notice is the lump (or sometimes a little hole or pit) in the skin of the palm near the base of the ring finger. This lump is usually painless but can be tender to direct pressure.
Months or even years later the lump can develop into a band passing into the finger or fingers. Again months or years later this can start to pull the finger down to the hand so the finger will not fully straighten. This is called a Dupuytren’s contracture. People often notice this when they cannot put their hand down flat or have problems putting their hand in a pocket or putting on gloves.
The disease usually affects both hands but one hand may be much worse. Eventually in the worst cases all the fingers and even the thumb can be affected.
The ability to grip is not affected until the very severe stages when the fingers are pulled so far down that it is impossible to open them to hold things.
Many people find that the condition is a nuisance but does not preclude most normal activities. Some activities you may have problems with include:
- Holding some tools
- Holding a ball eg for bowling
- Getting your hand into small places.
Many people with Dupuytren’s do not require surgery. Surgery is offered for three reasons:
- There is a significant contracture progressing rapidly which will require major surgery if left for longer.
- There is a contracture causing significant problems with your hand function
- The lump in the palm is very painful
Conservative: This means treatment without operation. There is some evidence that splints will help Dupuytrens and so some people can be given a splint to wear at night time to prevent progression of their problem. However most surgeons believe that the success rate of this treatment is very low and will not suggest it for rapidly advancing disease.
Injections: Patients with painful lumps in the palm can be treated with a steroid injection into the lump. This injection is quite painful and probably has a 50% success rate in the short term. There is no evidence that this prevents progression of the disease into a band.
This is the mainstay of treatment and can be of several types varying in complexity and complications.
Repeat operations are often a mixture of the above operations but may require more surgery to the actual joints in the fingers which adds to the recovery time.
Joint fusion is a last stage operation as is amputation when there is no other way of improving the function of the hand. They are very rare operations.
Splints: Almost every patient will be made a special splint which must be worn at night time for six months.
Physiotherapy: Every patient will be referred to physiotherapy for advice on mobilising the hand. This can be quite painful and may need to be continued for up to six months
- Incomplete correction: In some patients it is not possible to fully straighten the finger. This is especially common if the finger has been bent for many years or if the finger is bent at the small joints as well as at the knuckle.
- Nerve damage: The Dupuytren's tissue is always wrapped around the small nerves in the finger. In a small proportion of patients (5-10%) the nerve is damaged and you will be left with some permanent or temporary loss of feeling at the tip of the finger. In addition a number of patients will find that the finger is painful in cold weather (10%).
- Recurrence: Dupuytren's is a disease that can come back. However the majority of patients will not require further surgery to an operated finger. Approximately 15% of patients requiring surgery to the little finger will develop a recurrent contracture of the same or worse severity in the first six months after surgery.
- Infection: A small proportion of patients will develop infection (more common in patients with diabetes) and require further surgery or even amputation.
- Skin graft failure: 10% of skin grafts can be expected to fail partially or completely and require either prolonged dressings or a further skin graft.
- Reflex Sympathetic Dystrophy: This is a condition that affects 1 in 2000 patients having hand surgery. The patients develop severe pain, swelling and stiffness in the hand. Despite treatment no patient will have a normal hand after this problem.
Experimental--"Clinical trials are in progress to investigate non-operative therapy for Dupuytren's disease using BioSpecifics injectable Collagenase (Cordase tm). The FDA has accorded "Orphan Drug Status" to this usage and a U.S. patent has been granted. A research grant for continued clinical investigation in this area at Stony Brook Medical Center was awarded to BioSpecifics by the New York State Center for Advanced Technology in Medical Biotechnology. The FDA Office of Orphan Product Development has provided some of the funding for the trials in Stony Brook. A second double blind controlled trial is now underway to further define collagenase's usefulness for this condition."
- Duputren's Disease: History, Diagnosis, and Treatment; Plastic and Reconstructive Surgery, Vol 120, No 3, 790-
- The Vikings and Baron Dupuytren’s Disease--ADRIAN E. FLATT, MD, Baylor Health (very nice article)
- Dupuytren's Contracture by Charles Eaton, MD
- Dupuytren's Contracture--American Society for Surgery of the Hand (ASSH)
- A Patient's Guide to Dupuytren's Contracture--eOrthopod article
- Collagenase in the Treatment of Dupuytrens Disease--ClinicalTrials.gov
- Dupuytren's Disease--Pulver Taft Hand Centre
- Dupuytren's Contracture--NHS Choices