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Dupuytren's Disease

Topic Overview

What is Dupuytren's disease?

Dupuytren's (say "duh-pwee-TRAHNZ") disease can change how your hand looks and may make it hard or impossible to use one or more of your fingers.

Dupuytren's disease causes tissue under the skin of the palm of your hand to thicken and shorten. This can pull and bend the fingers in toward the palm. You may not be able to straighten them.

The disease gets worse slowly but rarely causes pain. You can treat it, but there is no cure. It may only involve the palm and never affect your fingers. And you may never need treatment.

Dupuytren's disease occurs most often in people ages 50 and older. It often affects both hands and can sometimes affect the soles of the feet.

Dupuytren's disease is also called Viking's disease.

What causes Dupuytren's disease?

The cause of Dupuytren's disease is not known. The tendency to get it is probably inherited, because the disease tends to happen in families. The thickening of the tissue may be related to alcoholism, smoking, or diabetes.

What are the symptoms?

You may first see or feel a small lump in the palm of your hand, usually near where your ring finger and small finger meet.

As Dupuytren's disease gets worse, a fibrous cord may develop in the tissue of the palm. The cord may extend to one or more fingers, usually the ring or small finger. The cord may pull your finger toward your palm. This is called Dupuytren's contracture.

At some point you may not be able to fully straighten your fingers or flatten your hand on a table. You may find it hard or impossible to do things like put on gloves, wash your hands, or pick up things.

The disease usually does not cause pain. If you do have pain, it’s most likely when you first get the disease.

How is Dupuytren's disease diagnosed?

Your doctor will look for skin changes on your palm and feel for any knots or a cord. He or she will ask you to move your hand, wrist, and fingers. Your doctor will ask you questions about your family and your symptoms. Your doctor also will ask you about smoking and alcohol use.

How is it treated?

The goal of treatment for Dupuytren's disease is to keep your hand working as best as it can.

  • Some doctors are using a treatment called needle aponeurotomy to separate the tight cords in the palm using a needle.
  • A medicine called collagenase (such as Xiaflex) may be injected to try to dissolve some of the tight tissue.
  • Surgery may be recommended if you cannot straighten your fingers or pick things up.

Frequently Asked Questions

Learning about Dupuytren's disease:

Being diagnosed:

Getting treatment:

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  Dupuytren's Disease: Should I Have Hand Surgery?

Cause

The cause of Dupuytren's disease is unknown. Heredity is a factor: Dupuytren's disease tends to occur most often in people of northern European descent and among close family members. The thickening of the tissue between the skin and tendons, called the palmar fascia, may be related to one or more things, such as:

Symptoms

Dupuytren's disease usually does not cause pain. When pain does occur, it often is early in the disease or may happen if inflammation develops.

The first noticeable symptoms of Dupuytren's disease may be:

  • A small knot that may be visible or felt on the palm, usually near the base of your ring or small fingers. The knot is sometimes sensitive to pressure. And it may gradually thicken and begin to pull one or more of your fingers toward the palm.
  • Dimpling that appears on the skin of your palm when the diseased tissue (palmar fascia) between the skin and tendons pulls on the skin.

As the disease progresses, a fibrous, ropey cord may gradually develop in the palmar fascia and connect your palm to one or more fingers, usually the ring or small finger. The cord pulls your finger toward the palm, which is called Dupuytren's contracture. Eventually you will not be able to flatten your palm on an even surface, such as a table. When it is severe, Dupuytren's contracture can make certain everyday activities—such as picking up items, putting on gloves, or washing your hands—difficult or impossible.

Other conditions that may cause symptoms similar to those caused by Dupuytren's disease include rheumatoid arthritis and work-related injuries.

What Happens

Dupuytren's disease is often not noticed until it becomes severe. The tissue between your skin and tendons, known as the palmar fascia, becomes abnormally thick and fibrous. It is not yet clear what causes this thickening.

There are three general phases of the disease:

  • Early. You may notice a small knot on the palm or at the base of the fingers. There is no pulling or contracture between the fingers and the palm.
  • Active. Dimpling appears on the skin of the palm due to the growth of the thickened palmar fascia. Long, ropey cords and bands also develop in the fascia, stretching from the palm to one or more fingers. The cord can sometimes be seen and felt.
  • Advanced. The thickened palmar fascia and cord cause a rigid, disabling contracture when the finger is drawn towards the palm. Eventually you will not be able to flatten your palm on a table or other even surface. Very severe forms of the disease result in an inability to do routine tasks, such as using silverware.

The disease usually progresses slowly. It most often occurs after age 50. Many people have a mild form that does not cause significant problems. But a rare form called Dupuytren's diathesis occurs at an early age and progresses rapidly.

Dupuytren's disease often develops in both hands of people with the condition, and it most commonly affects the ring and small fingers.

What Increases Your Risk

You are at an increased risk of developing Dupuytren's disease if you:

  • Have a family history of the disease.
  • Are of northern European heritage.
  • Are a male.
  • Are over age 50.
  • You smoke.

Dupuytren's disease seems to occur more in people who have certain diseases or disorders, such as diabetes or alcoholism. It may also occur more often in people who have epilepsy or are being treated with anticonvulsant medicines.1

When To Call a Doctor

Call a doctor if you notice:

  • Dimples or knots in your palms, especially near the base of your fingers.
  • An inability to flatten your hand, palm down, on an even surface.
  • Pain in your palm or fingers.

Watchful waiting

Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. This period may vary from a few weeks to months or years. Dupuytren's disease usually is a slowly progressing disease.

Who to see

The following health professionals can diagnose Dupuytren's disease:

A hand surgeon, orthopedic surgeon, or plastic surgeon can also diagnose and treat Dupuytren's disease. These doctors are most often seen for severe disease, when you cannot use your hand for everyday activities.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Dupuytren's disease develops slowly and may be hard to diagnose in its early stages. Most people do not see a doctor until the disease has progressed. A medical history and physical exam usually provide enough information for your doctor to determine whether you have Dupuytren's disease.

Questions about your medical history for Dupuytren's disease will usually include:

  • Whether any close family members have been diagnosed with Dupuytren's disease or have had any similar symptoms.
  • Your ethnic background.
  • The symptoms and signs you've experienced and for how long.
  • Whether you've noticed similar symptoms on the soles of your feet.
  • Whether you've experienced any pain in your hand.
  • Whether you have a history of smoking or alcoholism.
  • Whether you have other medical conditions, such as diabetes.

A physical exam for Dupuytren's disease will usually include:

  • Moving your hand and wrist in various positions.
  • Moving your fingers to check for flexibility.
  • Feeling the palm of your hand for a knot (nodule) or cord.
  • Looking for any skin changes on your hand, such as dimpling or thickening on the palm.

Treatment Overview

The goal of treatment for Dupuytren's disease is to keep or restore hand function. Dupuytren's disease often is a progressive disease, and recurrence is common.

Initial treatment

Dupuytren's disease often develops slowly. If the tissue (palmar fascia) between your skin and tendons does not thicken to the point that your fingers are bent and cannot be straightened (contracture), you may only need to have your palms checked regularly.

Stretching exercises and splints have been tried to control the early stages of Dupuytren's, but they have not been shown to slow the progress of the disease.

Ongoing treatment

Treatment for Dupuytren's disease depends on how bad the disease is. You may notice the characteristic nodules in your palms years before your condition interferes with daily activities, or you may never have a reduction in your range of motion.

Collagenase (such as Xiaflex) injected into the tight cord can help reduce the contracture and improve the range of motion.2

Treatment if the condition gets worse

In severe Dupuytren's disease, the tissue (palmar fascia) between your skin and tendons thickens to the point that your fingers are bent and cannot be straightened (contracture). If you lose the ability to wear gloves or hold objects, or if your hands become painful, a procedure may be done to relieve the contracture. Surgery is most common, but some doctors are now doing needle aponeurotomy.

In needle aponeurotomy (also called percutaneous needle fasciotomy), a local anesthetic is injected into the palm. A needle is used to put small holes in the tight cords. The fingers are then extended to separate the cords. A splint is used to keep the finger straight as it heals.

Surgery can restore mobility to your hands, but Dupuytren's disease recurs often and reoperation may be needed to keep hand function. After surgery, a sustained program—including using splints, stretching, and doing scar tissue massage and hand exercises—may help you regain mobility and prevent complications or recurrences of the disease.3

What to think about

Click here to view a Decision Point.Dupuytren's Disease: Should I Have Hand Surgery?

Prevention

Dupuytren's disease, an abnormal thickening of tissues in the palm, cannot be prevented. The tendency to get it is probably inherited (passed from parents to children).

Home Treatment

Home treatment for Dupuytren's disease focuses on keeping as much hand mobility as possible. Stretching exercises and splints have been tried to control the early stages of the disease, but there is not much evidence that they help keep your fingers flexible or slow the disease process. Most people still try massage and stretching exercises. Even though the disease continues to progress, massage and stretching are simple to do, and they may help your hand stay as flexible as possible. You can also try to avoid curling your hand tightly. For example, you can use utensils and tools that have larger hand grips.

If a procedure such as surgery or needle aponeurotomy is needed, home rehabilitation after the procedure may help prevent complications and recurrences of the disease. Try elevating the hand and arm to prevent swelling, wearing a splint as your doctor recommends to prevent recurrence of contracture, and exercising to keep or regain hand movement.

After surgery, you can help your scar heal successfully, as guided by your doctor. Scar management may include therapeutic hand massages by a rehabilitation specialist; massaging your hand at home, usually 2 or 3 times a day, following your hand therapist's instructions; and using a splint that keeps pressure against your palm and fingers.

Medications

Medicines that you take by mouth are typically not used as part of treatment for Dupuytren's disease. But there is an injected medicine called collagenase (such as Xiaflex) that may help.

Surgery

Surgery is a treatment option for severe cases of Dupuytren's disease. The goal of surgery is to restore the use of your fingers and hand. In most cases, surgery removes the diseased soft-tissue bands that connect your finger joints to the palm, and it may involve a skin graft. Total hand function may not be completely restored by surgery. Even with successful surgery, thickened palm tissue may develop again in the same place or in a new area of the hands. Reoperation is often needed to keep hand function.

You may improve the outcome if you do postsurgical rehabilitation with finger exercises and splints, as directed by your health professional.

Click here to view a Decision Point.Dupuytren's Disease: Should I Have Hand Surgery?

Surgery choices

Depending on your condition, your surgeon will choose one of the following surgical procedures:

  • Fasciectomy. Removal of the affected tissue (fascia) is the most common procedure.
  • Fasciotomy. The tight cords in the palm are divided through small incisions. This procedure is used for people who cannot have more extensive surgery or general anesthesia.
  • Amputation. Removal of one or more fingers is rarely needed but may be done if earlier procedures have resulted in nerve or vessel damage or the disease has recurred repeatedly.

In rare cases, the middle joint of the finger is fused (permanently joined) to keep it from bending in.

What to think about

When you are deciding about surgery, think about:

  • The presence of any other health conditions or diseases, such as diabetes.
  • Your willingness to go through postsurgery rehabilitation, which is needed in order to restore hand function.
  • How bad your loss of hand function is and how you are affected in your daily activities.
  • Your age. The risk of complications and treatment failure are greater with advanced age.

Needle aponeurotomy is a form of fasciotomy that is done as an outpatient procedure with local anesthesia. This procedure may be good for people who cannot have surgery, or as a way to delay surgery. But it only partially corrects pulling or contracture between the fingers and the palm. Also, there is chance of damaging nerves of the adjacent fingers. And there is a high chance the contracture will come back.

Other Treatment

Rehabilitation (treatment by a physical therapist or occupational therapist) is a necessary step in recovery after surgery on the hand. The goals of rehabilitation are to prevent the buildup of fluid (edema), to manage scarring, and to get back and keep your range of motion. It may include wrapping, splinting, massage, stretching, and exercise. Your therapist may also recommend using bigger grips or handles on equipment so you don't have to bend your fingers as far.

Other Places To Get Help

Organizations

American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Road
Rosemont, IL  60018-4262
Phone: (847) 823-7186
Fax: (847) 823-8125
Email: orthoinfo@aaos.org
Web Address: www.orthoinfo.aaos.org
 

The American Academy of Orthopaedic Surgeons (AAOS) provides information and education to raise the public's awareness of musculoskeletal conditions, with an emphasis on preventive measures. The AAOS website contains information on orthopedic conditions and treatments, injury prevention, and wellness and exercise.


American Society for Surgery of the Hand (ASSH)
6300 North River Road
Suite 600
Rosemont, IL  60018-4256
Phone: (847) 384-8300
Fax: (847) 384-1435
Email: info@assh.org
Web Address: www.assh.org
 

ASSH is a professional organization of hand surgeons that provides education to the public about hand problems, such as Dupuytren's disease, carpal tunnel syndrome, and tennis elbow. ASSH also provides education about surgery, preventive tips to keep your hands safe, and an online tool to find a hand surgeon.


References

Citations

  1. Townley WA, et al. (2006) Dupuytren's contracture unfolded. BMJ, 332(7538): 397–400.
  2. Hurst LC, et al. (2009). Injectable collagenase clostridium histolyticum for Dupuytren's contracture. New England Journal of Medicine, 361(10): 968–979.
  3. Hertling D, Kessler RM (2006). Dupuytren's contracture section of Wrist and hand complex. In D Hertling, RM Kessler, Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods, 4th ed., pp. 421–422. Philadelphia: Lippincott Williams and Wilkins.

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer Herbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery
Last Revised March 22, 2012

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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