Consultant Trauma and orthopaedics
Dupuytren’s Disease (also referred to as Dupuytren’s contracture) is a common condition affecting the hand (and sometimes the feet).
Hard nodules/ lumps appear just beneath the skin in the palm of the hand and in some cases form thick cords which can prevent the fingers from straightening fully.
Why does it occur?
The cause is unknown, however, it is more common in individuals of Northern European descent and often runs in families. Dupuytren’s tends to affect people aged 40-60years and is more common in males than females.
There are some links with diabetes, smoking and high alcohol intake but many people affected have none of these.
Despite popular belief, there are no links with heavy manual work.
Sometimes Dupuytren’s may appear /its progress accelerates following an injury/ surgery to the hand or wrist.
What are the symptoms?
Dupuytren’s begins with hard lumps/ nodules in the palm of the hand which can be slightly uncomfortable in the early stages. It may then form thick cords that extend into the finger and can prevent the finger from straightening fully. It can affect one or more fingers – most commonly the little and ring fingers.
What tests might be done?
Doctors do not need to perform tests/ X-rays to diagnose Dupuytren’s disease but they may measure the degree to which your fingers are affected/ contracted to determine whether it requires surgical intervention. Surgery is not recommended if the fingers can be fully straightened.
What is the treatment?
There is no cure for Dupuytren’s but there are treatments that can be performed to destroy/ remove the offending cords and straighten the finger(s). You will need to discuss the most appropriate course of treatment with your surgeon.
Non-Operative Treatments include:
Splinting: not shown to be successful particularly in advanced/severe Dupuytren’s
Collagenase Injections: The aim of which is to break down the Dupuytren’s cord through injecting a solution into the hand. The surgeon may then manually straighten the affected finger(s)
Operative Treatments include:
Needle Fasciotomy: This involves dividing the Dupuytrens cord by using a needle in the palm/finger/both. Can be done under local anaesthetic
Fasciectomy: This involves an operation where an incision will be made in the palm (normally zig-zag in shape) and the cord will be divided and removed and the finger(s) then straightened
Dermo-fasciectomy: For severe contractures, a skin graft (normally from the upper arm) may be taken to fill particularly damaged areas of skin in the palm
What to expect after your operation.
Fasciectomy surgery is normally performed as day case surgery under a general anaesthetic or a regional block (where the arm is made numb using an injection).
You will be sent home with thick bulky dressings in order to keep your fingers straight.
You will be seen by a Hand Therapist within 3-5 days of your surgery who will remove the dressings and apply smaller ones to enable your fingers to move freely. They will also provide you with a splint that is needed after the surgery to make sure the affected finger(s) stay straight.
Stitches will be removed 10-14 days after your operation.
You will need to wear this splint at night time for around 10-14 weeks after your surgery to ensure that whilst the hand heals your finger remains straight.
Things to consider before having a Fasciectomy:
There are some risks attached to surgery that should be considered and discussed:
Risk of infection.
Risk of disease re-occurring
The finger may not go back fully straight – particularly if it involves the middle joint of your finger.
Risk of nerve injury causing tingling or numbness on one side of the finger through surgery.
Risk of Reflex Sympathetic Disorder (RSD). Can also be known as Chronic Regional Pain Syndrome (a malfunction of the nervous system that controls your pain).
Risk of problematic scar tissue. After the operation, there is a risk that you may have problems with scarring including tender/ sensitive scarring. Thick/ hard scarring causing reduced movement.