DUPUYTREN’S DISEASE
Dupuytren’s Disease Treatment in Galway | Hand Surgery
What is Dupuytren’s disease?
Dupuytren’s disease is an abnormal thickening of the tissue just beneath the skin, known as the fascia. This thickening occurs in the palm and can extend into the fingers. Firm cords and lumps may develop that can cause the fingers to bend into the palm., in which case it is called Dupuytren’s contracture. Although the skin may be involved in the process, the deeper structures, such as tendons, are not directly involved. Occasionally the disease will cause thickening on top of knuckle pads or nodules or cords within the soles of the feet (plantar fibromatosis).
Signs and symptoms
Symptoms of Dupuytren’s disease usually include lumps and pits within the palm. The lumps are generally firm and adherent to the skin.
Thick cords may develop, extending from the palm into one or more fingers., with the ring and little finger most commonly affected.
These cords may be mistaken for tendons, but they actually lie between the skin and the tendons. These cords cause bending or contractures of the fingers.
In many cases, both hands are affected, although the degree of involvement may vary.
The initial nodules may cause discomfort, but Dupuytren’s disease is typically not painful.
The disease may first be noticed because of difficulty placing the hand flat on an even surface.
As the fingers are drawn into the palm, one may notice difficulty with washing, wearing gloves, shaking hands or putting hands into pockets.
Progression is unpredictable - some will only have small lumps or cords, while others will develop severely bent fingers.
More severe disease often occurs at an earlier age of onset.
Treatment for Dupuytren’s disease
In mild cases, if hand function is not affected - only observation is needed. For more severe cases, options include injections or surgery. Your surgeon will discuss the most appropriate treatment option for your condition based on the stage of the disease and the joints involved. The goal of the treatment is to improve finger position and thereby improve hand function. Despite treatment, the disease may recur. Before treatment, your surgeon will discuss realistic goals, possible risks and results.
Specific surgical considerations
The presence of a lump in the palm does not mean that surgery is required or that the disease will progress.
Correction of finger position is more likely if the contracture affects the base of the finger or if the contracture is mild. Complete correction sometimes cannot be achieved, especially in the middle and end joints of the finger.
Skin grafts are sometimes required to cover open areas in the finger if the skin is deficient.
The nerves that provide feeling to the fingertips are often intertwined with the cords.
Splinting and hand physiotherapy are often required after surgery in order to maximise and maintain the improvement in finger position and function.
What causes Dupuytren’s disease ?
The cause is unknown but may be associated with certain biochemical factors within the fascia.
The problem is more common in men over the age of 40 and in people of Northern European descent.
There is no proven evidence that hand injuries or specific occupational exposures lead to a higher risk of developing Dupuytren’s disease.
