In the UK, more than two million people are thought to have Dupuytren’s disease. It’s more common in people over 50, and especially in men. It particularly affects people from a northern European background and runs in families.
Dupuytren's disease begins with firm lumps or nodules forming in your palm, often in line with your fourth (ring) finger. These are caused by thickening of the layer of tissue just under the skin. These nodules aren’t usually painful.
About one person in three who has Dupuytren’s disease will find the nodules progress and increase in size to form rope-like cords that pull the finger towards the palm and prevent it straightening fully. Although it can look as if it’s your tendon causing this, in fact it’s the thickened layer of tissue below your skin causing the problem. Without treatment, one or more of your fingers may become fixed in a bent position. This process is known as contracture. The process of your fingers becoming contracted is usually slow, and happens over many months and years rather than within weeks.
The cause of Dupuytren’s disease isn’t known but it appears to run in families. Other factors that seem to increase the chance of developing this condition are:
There is some evidence that the condition could be made worse by certain types of manual work, especially the use of vibrating tools. A one-off hand injury may, in rare cases, trigger the start of Dupuytren’s disease.
If you think you have contractures caused by Dupuytren’s disease and it’s affecting your hand function, see your GP. He or she will ask about your symptoms and examine you. He or she may also ask you about your medical history. One test you may be asked to carry out is to lay your hand flat, palm down on a table. This won’t be possible if you already have Dupuytren’s contractures.
There are a variety of treatments for Dupuytren’s disease that aim to straighten your fingers. The most common treatments involve some form of surgery.
You’re unlikely to be offered any medicines to treat Dupuytren’s disease because none have been proven to work yet.
This is a new treatment that has recently been authorised in the UK. Collagenase is a protein that can break down the contracted cords. Collagenase is injected into the affected cord and the next day the treated joint is carefully manipulated to try to make the cord break. You’re likely to be given a splint to wear at night for up to four months. There is evidence that about two-thirds of people who had this treatment found that their fingers could almost fully straighten again. However, collagenase treatment isn’t suitable for all people who have Dupuytren’s contractures.
There are a number of different types of surgery. You will need to discuss with your surgeon which option is most suitable for you.
This is the most minor, minimally invasive surgery. This option is more likely to be considered if you can’t have a general anaesthetic because this type of surgery is carried out under local anaesthesia. Local anaesthesia blocks pain from the area where the needle will be inserted into your skin and you will stay awake during the procedure. Your surgeon will insert a needle through the skin on top of the contracture and use it to divide the cord of Dupuytren’s tissue.
Needle fasciotomy can give a short-term improvement in the severity of a contracture. However, your contracture is likely to return, although this depends on the severity of your disease before the surgery was carried out.
You can have this procedure again in the future if your contracture returns.
In this operation, your surgeon will make a cut in your palm and affected fingers, and remove the thickened tissue beneath the skin that is causing the contracture. This can be carried out under regional or general anaesthesia. Regional anaesthesia completely blocks the pain from your hand or arm and you will be awake during the procedure. With general anaesthesia you will be asleep for the whole operation. The contracture comes back in up to six out of 10 people who have this procedure, so you may be offered dermofasciectomy, which has evidence of a lower recurrence rate.
This is a more complex surgical option that involves removing both the outer skin layer and the underlying thickened Dupuytren’s tissue. This is done under general anaesthesia. A skin graft, usually taken from your arm or groin, will be needed to replace the outer skin layer that has been taken away. You’re more likely to be offered this type of operation if the outer skin layer is involved in your contracture, if the contracture started when you were younger (under 50) or if the disease keeps coming back after previous operations.
You will usually only be offered radiation therapy during the early stages of Dupuytren's disease and probably only as part of a research study. The nodules and cords are treated with radiation with the aim of reducing their size and slowing their progression. There isn’t a lot of evidence about how well it works. Also, it may be better to wait to see if your nodules begin to form contracture cords because in many people this doesn’t happen. Further research into this procedure is being encouraged.
You may find that having Dupuytren’s disease doesn't cause you many problems. However, if it becomes severe enough to affect your life so that daily tasks become difficult, see your GP.
Documents & downloads: