Dupuytren’s Disease

Dupuytrens Disease is characterised by thickening of the tissues in the palm of the hand, often extending into the fingers and thumb. Initially, these thickened nodules resemble hard callouses, but it soon becomes obvious that they extend deeper and wider than just thick skin. It can affect any finger, but is most commonly seen in the little and ring fingers. It is rarely painful.

A lot of people have palmar nodules, but when the nodules join together to form 'cords', they contract and can pull the fingers into the palm. There is never a problem about making a full fist or grip in Dupuytrens Disease, but it may be impossible to fully straighten the affected fingers. Some doctors rely on the 'Table Top Test' to decide when an individual would benefit from treatment. That means, when it is no longer possible to lay the hand flat, palm-down, on a flat table surface. This is now regarded as an inaccurate measure of disability, and most Hand Surgeons will begin to offer treatments when a patient describes activity-specific difficulty in using their hand because the fingers will no longer straighten. This may be difficulty getting gloves on, or getting the hand into a trouser pocket, or maybe poking your eye with the bent finger when washing your face.

Population studies have shown that Dupuytrens Disease has been more densely concentrated in areas of the world once dominated by the Vikings. For that reason, it is often called 'The Viking Disease', although with the mobility of modern times, this effect is diminishing. Dupuytrens Disease does seem to run in families, however, although it does not always appear in every generation. The tendency to develop Dupuytrens contracture is located in the DNA of every cell in the body. Hence, eradication of the disease (cure) is impossible. Dupuytrens Disease will always return after treatment, although it can take decades to do so. Cigarette smokers are more prone to develop contractures.

Treatment of Dupuytrens Disease will be considered when hand function is compromised. There is no evidence to suggest that anything other than surgery will be effective as a treatment. Surgery consists of removing the affected thickened tissue from the palm and fingers through zig-zag scars, ensuring that the vital nerves, arteries and tendons remain undamaged. Sometimes the overlying skin is so densely involved in the disease that it is removed as well, and replaced by a skin graft. In people undergoing repeated surgery for regrowth in the same area, a skin graft will be considered to try and prevent further recurrence at that site.

 

     

 

Surgery is usually offered as a day case procedure, often under regional anaesthesia. The patient will wear bandages, sometimes with a plaster of Paris splint, for up to two weeks. Surgery for Dupuytrens Disease does have potential risks. Not only is recurrence inevitable, but the surgeon can never guarantee a complete correction of any contracture. Numbness, stiffness, infection and bleeding are all recognised to occur, albeit rarely. Temporary tingling in the finger end is quite common but usually resolves after a few weeks. The scars in the palm require regular massage with a simple, non-perfumed hand cream to make them mature quicker and become supple again. Patients should learn to do this themselves several times each day as soon as the scars are healed.

  

 

These photographs (above) show the healed skin graft, together with the ability to fully bend and straighten the fingers after healing. The donor site for the skin graft is shown on the inner forearm.

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