Information for patients with Dupuytren's Disease.
Edited By: Thomas Trumble, M.D.
Last updated Wednesday, December 30, 2009
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Figure 1 - The typical appearance of a hand affected by Dupuytrens contracture.
Figure 3 - the appearance of hands after fasciectomy.
Figure 4 - the appearance of hands after fasciectomy.
Prognosis and impacts
Characteristics of dupuytren's disease
Dupuytren's disease, or Dupuytren's contracture is a condition of
the hands that causes both a loss of mobility and an abnormal position
of the fingers and/or thumb. Patients with Dupuytren's disease develop
abnormal lumps and "cords" of tissue in the palm and fingers. These
lumps and cords represent an abnormal growth of the palmar fascia — the
"gristle" like tissue normally present in the hand that holds the skin
of the palm in place.
As the Dupuytren's cords tighten over time, the joints of the
fingers are pulled into flexion, causing the fingers to be pulled down
into the palm, and impairing the ability to straighten the fingers. The
thumb may also be affected, though this is less common. The rate at
which symptoms progress is highly variable among patients. In many
patients the disease may be stable over a long period of time and
require observation only. In others, it may progress more rapidly and
require earlier surgical intervention.
Patients with a strong family history, and the presence of related
conditions such as Peyronie's disease (abnormal fascial growth in the
penis), Ledderhosen disease (a condition similar to Dupuytren's disease
affecting the soles of the feet) and knuckle pads (lumps of abnormal
tissue over the knuckles) are more likely to have more severe and rapid
progression. As the condition progresses, the flexion deformity can
worsen, and the patient can lose the ability to straighten out the
affected fingers. The lumps and cords can also be painful. Figure 1
shows the typical appearance of a hand affected by Dupuytrens
contracture.
Types
Dupuytren's disease has not been classified into specific subtypes.
There is, however, a wide variation in the degree to which patients may
be affected. This ranges from very mild contractures of a single digit,
to severe contractures of several digits. Early on in the disease
process, affected individuals may only have a small lump of abnormal
tissue in the palm (a Dupuytren's nodule). Some patient's are said to
have a strong "Dupuytren's diathesis". This refers to patients with a
strong family history and who may have associated conditions such as
Peyronie's disease, Ledderhosen disease and knuckle pads (described
above). In these patients, Dupuytren's disease is often more aggressive
in nature.Similar conditions
There are few conditions that can be confused with Dupuytren's disease.
Other conditions that may cause in inability to fully straighten the
fingers include trigger finger (which occurs more commonly in patients
with Dupuytren's disease), extensor tendon rupture (due to injury or
arthritis), joint stiffness following injury and/or immobilization of
the hand in a splint or cast, joint stiffness due to arthritis, injury
to the ulnar nerve resulting in a ¡§claw hand¡¨ deformity, or
subluxation (slipping) of the extensor tendons between the knuckles in
patients with arthtritis. However, none of these conditions result in
the palmar nodules and cords seen in Dupuytren's disease, making the
clinical diagnosis of Dupuytren's disease relatively straight forward.
Confusion may occur when Dupuytren's disease and one or more of these
other conditions are present in the same patient.Incidence and risk factors
Dupuytren's disease is most common in Caucasian males over 50 years
of age, though it also occurs in women and in younger patients. It has
also been shown to be more common in diabetics, patients with seizure
disorders, HIV positive patients, patients with hypothyroidism, and in
those who smoke and consume alcohol. Having blood relatives with the
disease also increases a person's chance of being affected, especially
in those with northern European ancestory. However, not all children of
an affected individual will develop the disease, and not all patients
with the disease will have an affected family member.
When several factors such as these are known to be linked to a
disease, but none can be shown to be directly responsible, the cause is
said to be "multifactorial". This means that there are several things
that can increase a chance that a person will be affected, but a single
cause is not known.
Diagnosis
Usually, affected patients notice an abnormal lump in their palm early
in the disease process and present to their family doctor. The
condition is usually recognized at this point prompting referral to a
hand surgeon who can assess and follow the patient with regard to the
need for surgical intervention. The diagnosis is based on the patients
symptoms and the physical exam. There are no special tests such as
x-rays, other imaging studies, or blood tests required to make the
diagnosis.Medications
Currently there are no medications used to manage Dupuytren's
disease. However, clinical trials evaluating the effectiveness of
collagenase injections are underway. Collagenase is an enzyme that
breaks down collagen, the molecule that makes up the cords of
Dupuytren's tissue in the hand. Initial studies have suggested that the
majority of patients may derive benefit in terms of improved finger
motion when treated with collagenase instead of surgery. The results of
the current trials will shed more light on this new technique. It will
also be important to assess the results over time in order to determine
the rate of contracture recurrence.
Other non-surgical treatments that have been reported include
radiotherapy, ultrasound, preoperative splinting, topical and injected
steroids, dimethyl sulfoxide (DMSO), colchicine and gamma-interferon.
None of these have shown sufficient benefit or become established
treatment options for Dupuytren's disease.
Exercises
Exercises have not been found to be an effective treatment for the
contractures associated with Dupuytren's disease. However, some
surgeons may refer patients to a hand therapist for stretching of a
severely involved finger prior to surgery, though this is not common.Possible benefits of palmar fasciectomy
In Dupuytren's disease, the flexion contractures that cause
disability are the result of an abnormal growth of the palmar fascia.
This abnormal fascia arranges itself as "cords" which tighten over
time, pulling the affected fingers into an abnormal position. Surgery
for Dupuytren's disease involves the removal, or excision, of this
abnormal tissue. By removing the abnormal fascia, the surgeon can often
restore motion to the affected fingers. Sometimes the finger cannot be
fully restored to normal, and some flexion contracture persists,
however, most patients experience an improvement in hand function after
surgery.
Surgery for Dupuytren's Disease at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USA
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