Dupuytren's Disease
What is Dupuytren’s Disease?
Dupuytren’s disease is a contracture disorder of the palm and fingers. Nodules and cords form which limit the motion of the finger. These contractures can become worse over time and prevent patients from extending their fingers and making putting on gloves or placing their hand in their pocket difficult. It is hard to predict how quickly the progression will occur. Often it is not painful but sometimes the cord rubs on the tendon which leads to inflammation. The cause is unknown but it is not neoplastic. The exact cause of Dupuytren’s disease is not well understood, but it is believed to be caused by a combination of genetic and environmental factors. Dupuytren’s disease is more common in people of European descent, especially those with Scandinavian or Celtic ancestry. It is also more common in men than in women and tends to develop in people over the age of 50.
Dupuytren’s disease is typically diagnosed based on a physical examination of the hand and fingers. The doctor will look for nodules or cords in the palm of the hand and assess the degree of finger contracture. In some cases, imaging tests, such as an MRI or ultrasound, may be used to help confirm the diagnosis.
Examples of Dupuytren Disease
Pits
Cord
If I only have a nodule will it get worse?
A study of 124 patients over 10 years showed that 10% of the nodules resolve, 20% will progress and require treatment and 70% will not progress (Gudmundsson et al).
Dupuytren’s Disease Treatment
Treatments are to reduce the contracture and improve motion. There is no cure for the disease as this is a chronic condition and recurrence is common and expected. Recurrence is more common in patients younger than 50, family history of the disease, men with Peyronie disease, bilateral hand involvement, and patients with thumb involvement.
Pit/Nodule treatment
Surgery is not recommended and if it becomes tender then injection can be performed. Radiation therapy is controversial and is not recommended.
If I have a contracture, when should I choose to fix it?
When patients have at least a 30-degree contracture or can not lay their hand flat on a table treatment is recommended. Full correction can often occur when MCP contractures less than 50 degrees and PIP less than 40 degrees. Larger contractures are harder to get back full straight this is especially true of the PIP joint.
Nonsurgical Treatment
Splinting, medications and therapy have not been shown to treat the disease.
Xiaflex is a collagenase injection that breaks up the Dupuytren’s cord. It is injected in a few locations into the cord and the patient returns to the office for a manipulation. Skin tears and bruising is expected. Lymph node swelling and hand swelling can also occur.
Needle Aponeurotomy or needle fasciotomy is often an in-office procedure that is more useful for MCP contractures than PIP contractures. It uses a syringe needle to cut the cord under local anesthesia. The finger is then straightened. Skin tears do occur as well as bleeding. Other complications that could occur include nerve injury, numbness, and tendon rupture.
The recurrence rate for collagenase and needle aponeurotomy is approximately 15% per yea
More Information comparing the two
Dupuytren’s Disease Surgery
Fasciotomy is the removal of the cord from the palm. Often the wounds are left open to heal by secondary intention to help prevent a recurrence. This means you will have a wound that is open and often have to perform self-care. The recurrence rate is 5% per year.
Dupuytren’s disease is a common condition that affects the hand and fingers, causing them to become bent or contracted. While there is no cure for this condition, there are several treatment options available to help manage the symptoms. If you are experiencing symptoms of Dupuytren’s disease, it is important to speak with a healthcare professional to determine the best course of treatment for your specific situation.
More information be found at Dupuytens Foundation
AAOS Website