Hand & Wrist: Dupuytren’s Disease


Dupuytren’s disease is abnormal thickening of the fascial tissue in the palm and/or fingers that progressively limit finger motion. Individuals with Dupuytren’s disease may first notice dimples or small bumps in their palms. As the disease progresses, the thickened tissue forms a cord that tighten and pulls the finger(s) into the palm. The cord does not allow for finger(s) to fully straighten, this is call Dupuytren’s Contracture.

Causes of Dupuytren’s Disease

The exact cause is unknown, but there is a genetic component. There is no evidence to suggest injury or occupation is a direct cause of the disease, though there is a higher incidence in high-level rock climbers.

Dupuytren’s disease tends to be more common in people with a history of diabetes, alcoholism, epilepsy, smoking, and those of Northern European descent. It is also more common in men that women.




Signs and symptoms of an Dupuytren’s Disease may include:
  • Firm lumps and/or pits in the palm of the hand. The lumps may be tender at first, but the tenderness usually goes away.
  • Thick cords may form from the palm into one or more fingers. As the cords tighten, it becomes more difficult to straighten the fingers.
  • Activities such as laying your hand flat, putting on gloves, putting your hands into pockets, and shaking hands may become increasingly difficult
Xiaflex injection

Xiaflex is a medication containing enzymes injected directly into the cord. The enzymes weaken the structure of the cord allowing your hand surgeon to manipulate and "break" the cord, which releases the contracture. This treatment involves two appointments; one to have the injection, and the second occurs one to two days after injection to manipulate the cord. Your finger will be straighter, but any lumps or bumps will remain.

Surgery

Surgery involves removing the diseased fascia from the hand/fingers and releasing any contracted joints in the operating room. Incisions are usually left open, without stitches, so wounds can heal without excessive stress. These wounds will heal on their own in about three to four weeks. Immediately after surgery you will be placed in a bulky dressing which must stay on until your first post-op appointment. The dressing needs to remain clean and dry to minimize the risk of infection.

Dupuytren's Disease Dupuytren's Disease Dupuytren's Disease

 

Hand with Dupuytren’s contracture, TRIA Orthopaedic Center
Advanced case of Dupuytrens with pits, nodules and cords leading to bending of the finger into the palm
Hand with advanced case of Dupuytren’s contracture, TRIA Orthopaedic Center
Advanced case of Dupuytrens with pits, nodules and cords leading to bending of the finger into the palm
drawing of hand doing table top test, Dupuytren’s contracture, TRIA Orthopaedic Center
Table top test

Courtesy of American Society for Surgery of the Hand