Dupuytren’s disease is an abnormal thickening of the tissue just beneath the skin of the palm in the hands or the feet. It often starts with firm lumps in the palm and then cords develop beneath the skin, stretching from the palm into the fingers. Gradually, these cords may cause the fingers to bend into the palm.
Although the skin may become involved in the process, the deeper structures such as the tendons, are not directly involved. Occasionally, the disease will cause thickening on top of the finger knuckles (knuckle pads) or nodules or cords within the soles of the feet (plantar fibromatosis).
Symptoms usually include a small lump or series of lumps and pits within the palm. The lumps are generally firm and adherent to the skin. Gradually a cord may develop, extending from the palm into one or more fingers, with the ring and little fingers most commonly affected. Both hands may be affected. The initial nodules may produce discomfort that usually resolves but Dupuytren’s disease is not typically painful.
As the disease progresses, it may cause difficulty with everyday activities. Progression is unpredictable. Some individuals will have only small lumps or cords while others will develop bends (contractures) in the fingers early. More severe symptoms often occur with an earlier age of onset.
Treatment is not usually required for nodules or simple cords.
Non surgical treatment may be appropriate for mild or moderate disease and will usually offer short to medium relief.
- Steroid Injections – Steroid injections are only useful for pain or triggering in the hand and nodules in the foot.
- Xiaflex® – Xiaflex is an enzyme that breaks down the dupuytrens disease tissue and can be used to release contractures in the hand. Xiaflex® treatment requires a fine needle and then manipulation a days later. It enables the patient to have their Dupuytren’s treated without going into hospital and with no anaesthetic required. Click for more information regarding Xiaflex®.
- Fasciotomy -This requires a minor in rooms procedure and is only useful for dupuytrens disease in the palm.
Surgery aims to release contractures and remove some diseased tissue. Sometimes, skin grafts or flaps may be required.
The nerves to the fingertips are often wrapped up in the contracture and may be damaged during surgery. This is usually partial and temporary. Sometimes, it may not be possible to completely release all of the contractures. Your surgeon would usually know this prior to surgery. Despite surgery, the disease process may recur and the fingers may begin to bend into the palm once again. Patients with more advanced contractures may require surgery in order to improve function.
Patients will need dressings for a few weeks after surgery. They will also need hand therapy to assist with movement and help prevent further contracture. Most patients will need to wear a splint at night for six weeks up to three months.
More Information on Dupuytren’s Disease
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Hand Dupuytren’s disease