Dupuytren's disease (also referred to as Dupuytren's contracture) is a common condition that usually arises in middle age or later and is more common in men than women. Firm nodules appear in the fascia just beneath the skin of the palm of the hand, and in some cases they extend to form cords that can prevent the finger straightening completely. The nodules and cords may be associated with small pits in the skin. Nodules over the back of the finger knuckles (Garrod's knuckle pads) and lumps on the soles of the feet are seen in some people with Dupuytren's disease.
The cause is unknown, but it is more common in Northern Europe than elsewhere and it often runs in families. Dupuytren's disease may be associated with diabetes, smoking and high alcohol consumption, but many affected people have none of these. It does not appear to be associated with manual work. It occasionally appears after injury to the hand or wrist, or after surgery to these areas.
Surgery is not needed if fingers can be straightened fully. It is likely to be helpful when it has become impossible to put the hand flat on a table, and should be discussed with a surgeon at this stage. The surgeon can advise on the type of operation best suited to the individual, and on its timing. The procedure maybe carried out under local, regional (injection of local anaesthetic at the shoulder) or general anaesthetic. Surgical options are:
1. Fasciotomy. The contracted cord of Dupuytren's disease is simply cut in the palm, in the finger or in both, using a small knife or a needle (needle fasciotomy).
2. Segmental fasciectomy. Short segments of the cord are removed through one or more small incisions.
3. Regional fasciectomy. Through a single longer incision, the entire cord is removed. This is the most common operation.
4. Dermofasciectomy. The cord is removed together with the overlying skin and the skin is replaced with a graft taken usually from the upper arm or groin. This procedure is usually undertaken for recurrent disease, or for extensive disease in a younger individual.
5 Xiapex. Recently an injection technique had been introduced into the UK, which dissolves the cord in a discreet area allowing the finger to be manipulated into a better position. The results are very promising
Dupuytren’s disease is a chronic condition involving the hands. It results in a fixed flexion of the fingers. Early assessment by a specialist is advised to diagnose and determine an individualized treatment pathway. Surgical and injection treatments are available.