Dupuytren’s Disease

Dupuytren’s disease is a progressive hand condition that develops slowly over a period of years, gradually deforming the hand due to nodules of tissue forming in the palm. These nodules (knots) pull the fingers into a permanent bending position.

Initially, small nodules appear in the palm of the hand. As the disease progresses, these nodules grow in size. Over these nodules, the skin takes on a shiny appearance. These nodules may be painful to palpate, or they may not cause any pain at all. Thick, fibrous, cord-like tissues gradually form on the palm near the little finger and the ring finger, affecting them so that even with effort, they cannot extend. This potential deformity can interfere with daily activities such as hand movement, hand washing, etc. In later stages of the condition, these tissue cords pull the fingers towards the palm in a permanent flexed position. The disease can occur bilaterally, although usually one hand is more severely affected.

The cause of the disease is unknown. Only some predisposing factors have been identified. Diabetic men over 50 years of age are the most commonly affected group of patients. People living in Northern Europe have a higher risk of developing the condition. Microscopic changes in the blood vessels of smokers may be a factor causing Dupuytren’s disease.

The treatment is designed to “break” the cords that have formed in the palm of the hand. This can be done in several ways, depending on the severity of the disease. The most common method involves the use of a needle, with which the doctor, percutaneously, makes holes in the fibrous cords to break up the tissue. This method provides a 3 to 5 year window where symptoms will disappear. In the fourth or fifth year after treatment, chances are that the disease will relapse. The advantages of the method are that it can be done on several fingers at once, but there is a risk of complications due to nerve or tendon damage. Transdermal injections of enzymes can also be given to chemically break down the fibrous tissue and release the fingers. In more severe cases, surgery is required to cut and remove the fibrous tissue, resulting in long-term relief. Post-operative physiotherapy and occupational therapy is needed.