What is it?
Dupuytrens disease is a common and potentially crippling condition where the fascia, normal tissue beneath the skin of the palm, becomes abnormal forming bundles that develop the ability pull the fingers in. As a result, the joints of the fingers over time can become drawn in, or contracted, and lose the ability to fully extend. It is a progressive condition without a prevention or a cure, although treatment exist for the symptoms.
What causes it?
Dupuytrens disease is a genetic condition that is more common in Caucasian individuals. It is determined by many genes and can skip generations.
Dupuytren’s disease typically begins in the fifth to sixth decades of life. Cords and nodules begin faintly in the palm and fingers, with a predilection towards involvement of the ring and small fingers. As the cords enlarge or spread over time, the fingers become contracted, or drawn in, and lack the ability to fully extend. The condition is usually painless.
How is it diagnosed?
Inspection of the palm during a physical examination is sufficient to arrive at a diagnosis.
How is it treated?
There is no known prevention of Dupuytren’s disease. Stretching exercises, once thought to be helpful, may actually accelerate the condition. Also, there is no cure for Dupuytren’s disease. Because Dupuytren’s contracture currently cannot be cured nor prevented, treatment is aimed at surgically correcting the contracture. In early stages of the condition, cords and nodules will exist without associated contracture of the digits. No treatment other than observation is needed at this stage. Occasionally, nodules may be painful, and this may warrant treatment with a steroid injection to shrink them or treat the pain. An easy way to evaluate for the presence of contracture is the table top test. If the palm can be laid flat on a surface, then no significant contracture requiring treatment is present. When contracture of the fingers is present, several treatment options are available. All treatment options aim to break the continuity of the cord, allowing extension of the digit. Surgical excision uses a variety of incisions to expose the cords and remove them. Two additional minimally invasive interventions are available. An injection of a collagenase, a medication that dissolves collagen, the building blocks of the Dupuytren’s cords, can be done to weaken the cord such that it can be manually ruptured. Lastly, a minimally invasive procedure can be performed in clinic under local anesthesia that uses a hypodermic needle to cut the cords. With the continuity of the cords disrupted the fingers can then be extended. After surgery, a period of splinting at night is usually required. Some patients will require therapy to help regain motion in the fingers. Recurrence of the condition is possible, requiring additional treatment in the future.
Are you ready to get treated? Book your appointment here.