Dupuytren’s DiseaseWritten by Dr Richard Lawson FRACS - Hand Surgeon
What is Dupuytren’s disease?
DD is a condition where the tough fibrous tissue in the palm, known as palmar fascia, begins to thicken and then to contract, often causing progressive bending of the fingers into the palm.
Why is it called Dupuytren’s disease?
A prominent French physician by the name of Guillaume Dupuytren described the disease in 1837, and while other doctors had described the disease before him, he gets the credit for it.
Who gets Dupuytren’s disease?
Dupuytren’s disease is sometimes called the curse of the Vikings, and is prevalent in those descended from Scandinavians and Celtic races such as the Scots. It is much less common in South Americans, Indians, and those from the Middle East.
Dupuytren’s disease occurs more commonly in men, and tends to occur at a younger age in men than in women, often starting in the 50s in men.
Are there any conditions associated with Dupuytren’s disease?
Smoking is a definite risk factor, and is yet another reason to quit in those with Dupuytren’s disease.
There are many other associated disease states, but most patients have none of these, and just happen to have DD.
Why do the fingers curl into the palm?
The abnormal cells in the DD tissue have components of muscle fibres within them, and these muscle fibres are able to contract. Because the contracting tissues lie on the palm side of the fingers, contraction causes flexion into the palm.
The flexion deformity can progress until the fingers are contracted into the palm.
Is there anything that can be done to prevent progression of the disease?
There are no known measures to prevent disease progression, although patients who smoke should definitely quit.
How is the disease treated?
The disease is treated by surgical removal of the diseased fascia. Removal of the fascia allows the bending down of the fingers to be partially or completely relieved.
The operation usually doesn’t tend to cure the disease permanently; there is a tendency to recur as time goes by. People who get the disease at a young age tend to have a recurrence earlier. Despite this, surgery can be a very worthwhile exercise, with a good correction of the deformity which may last for many years.
If surgery is needed for recurrent disease, skin grafts are frequently taken to act as a fire break, in an effort to retard further progression of the disease.
What happens after surgery?
Considerable work with the hand therapists is necessary to get the optimum results. Visits with the hand therapist will initially be weekly, then after 6-8 weeks will usually be second weekly. The biggest hurdle after surgery is regaining full flexion of the fingers, and a lot of work is required to achieve this.
What complications can occur as a result of surgery?
The fingers can become stiff, lacking flexion. The disease may recur and start to cause gradual flexion of the fingers into the palm again.
Infection, haematoma (blood collections) and problems with skin grafts may occur, as well as damage to the blood vessels and nerves in the fingers.
A rare but serious complication is RSD when the hand becomes stiff, swollen and painful, and this required.
Despite these alarming potential problems, the surgery usually goes well and provides satisfying results, although a lot of effort with hand therapy is required.