Dupuytren’s Disease

What is Dupuytren’s disease?

Dupuytren’s disease is a progressive thickening and tightening of the fascia over the palm the one or both hand. This can result in flexion (curling up) of fingers, especially the ring finger and little finger.

We don’t yet know what causes Dupuytren’s disease. But because it seems to affect mainly people who have a Viking heritage, we suspect there is a genetic basis to the disease. Men are affected more than women and most people develop the condition after 40 years of age.

What are the symptoms of Dupuytren’s disease?

The initial symptom is formation of a hard knots under the skin of the palm. These are occasionally tender, but they aren’t usually painful. Over time these knots become thick cord-like structures, which extend up to the fingers (usually to the ring finger and little finger). As the cords tighten and contract, the fingers are pulled down into the palm. Eventually you might not be able to completely straighten your fingers.

The deformity of the fingers makes it very hard to hold large objects and do things like open doors.

What does your doctor look for?

The disease is usually easy to diagnose as it has characteristic examination findings as described above. A simple test, called the Hueston’s tabletop test, is used to determine whether surgery should be performed. In this test, the affected hand is placed flat on the table and if you are unable to make your palm flat on the table, surgery should be considered.

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What investigations are needed?

No investigations are routinely ordered for Dupuytren’s disease.

How is Dupuytren’s disease treated?

Treatment options include:

Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.

Dupuytren’s disease surgery

Surgery is the mainstay of treatment as non-surgical treatments have so far not been shown to alter the course of the disease. More research is needed with treatments such as the collagenase injections.

Surgery is usually performed under a general anaesthetic as a day procedure. It takes between 30 and 60 minutes to perform. A tourniquet is placed above the elbow to ensure a bloodless field. A zigzag incision is made along the palm and out to the finger. Skin flaps are elevated and the tendons, nerves and arteries are identified and protected. The cord causing the contracture is identified and removed. Occasionally, a skin graft may be required if there is a significant skin defect on closure of the skin flaps. The skin is sutured closed and dressings and a plaster cast is applied.

The hand is immobilised inside the cast for 3-5 days. The wound is inspected 3-5 days after surgery and the sutures are usually removed 10–14 days post-surgery.

Post-op rehabilitation

After the sutures are removed, a splint is organised by your hand therapist to avoid early recurrence of the contractures. A separate splint is also organised to be worn at night for a further 3 months. You will be able to return to most activities of daily living once the sutures have been removed. You can to return to light work environments once the sutures have been removed, but heavy manual labour is often delayed for 4–6 weeks.

Possible complications

More than 95% of patients are happy with the results of the surgery, however complications do occur sometimes.

Some complications specifically related to hand surgery include:infection (less than 1% chance); neuroma (less than 1% chance), which is a damaged nerve that becomes painful on reattempts to regenerate; numbness; chronic regional pain syndrome or reflex sympathetic dystrophy (1-2% chance), which is a reaction to surgery that can cause painful or stiff hands.

Complications specific to Dupuytren’s contracture surgery include recurrence. This is common, but it may not occur to the level that requires further surgery. Occasionally, the surgery is unable to completely straighten the finger, especially in recurrent disease. Sometimes blood vessels and nerves to the finger may be damaged and leave one side of the finger numb or alter the blood supply to the finger. There may be specific wound breakdown of more complex incisions and more advanced disease.