Dupuytren's Disease

Dupuytren's disease (also called Dupuytren's contracture) is a thickening and shortening of the fascia, the fibrous tissue underneath the skin of the fingers and the palm. This thickened area may begin as a hard lump that can progress to a thick band which causes involved fingers to curl toward the palm, limiting extension or straightening of the finger.

A Dupuytren’s contracture typically progresses slowly and may remain mild. For moderate or severe cases, the condition can interfere with hand function. When this occurs, non-surgical and surgical treatment options can restore normal motion in the affected fingers; most often this involves the ring and little finger.

Orthopaedic hand surgeons at Brigham and Women’s Hospital (BWH) are experts at diagnosing and treating Dupuytren's disease with a range of options, including minimally invasive procedures such as enzyme injection, needle aponeurotomy and surgical approaches, including fasciotomy and subtotal palmar fasciectomy.

Causes

Dupuytren's disease has a number of risk factors which can make an individual more likely to get it, including:

  • Ancestry; Northern European, British Isles or Scandinavian ancestry.
  • Gender; Men are more affected.
  • Heredity

Symptoms

Symptoms often progress gradually over many years. Symptoms can include:

  • Decreased hand function
  • Not being able to put your palm flat on a table
  • Nodules or small lumps in the palm of the hand that are initially tender
  • Pits or grooves in the skin
  • Thick cords of tissue under the skin that pull fingers inward

Diagnosis

Your orthopaedic surgeon will evaluate your medical history and conduct a variety of tests to determine if you have Dupuytren's disease:

  • Physical examination that includes measuring range of motion and feeling in fingers and thumb, and recording the location of nodules and cords. These measurements will be compared to later measurements to assess disease progression.

Treatment

Non-surgical Treatment

If diagnosed early, symptoms of Dupuytren's disease may be reduced without surgery. Non-surgical treatments include:

  • Enzyme injection, a minimally invasive procedure done in an office visit and involving the injection of an enzyme solution into the cords in your hand. Over several hours to days, the enzyme breaks down and dissolves the contracted tissue. Your surgeon will snap the cords by manipulating and straightening your fingers.
  • Needle aponeurotomy involves passing the sharp end of a hypodermic needle back and forth through the restrictive cords to weaken and divide the diseased tissue.

Surgical Treatment

If non-surgical treatment does not relieve your symptoms, surgery may be recommended. Surgical approaches include:

  • Fasciotomy involves making an incision in your palm through which your surgeon divides the thickened tissue. Dividing the cord helps to decrease the contracture and increase finger movement.
  • Subtotal palmar fasciectomy involves a zig-zag incision along the creases in the hand through which all the abnormal tissue and cord is removed to straighten your fingers. On occasion a skin graft may be needed to help the wound heal.

Recovery

The length of recovery varies for each individual. You should expect some pain, stiffness and swelling. Elevating your hand above your heart and gently moving your fingers will help.

Our certified hand therapists can help reduce swelling and speed your recovery through wound care, and strength and flexibility exercises. He or she will fabricate a splint for you to wear during recovery.

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