Dupuytren’s Disease
Dupuytren’s disease is a syndrome where the fibrous tissue in the inner palmar fascia becomes unusually thick and short. Eventually, this unusual thickness ends up attaching the inner palmar fascia to the tendons, making one or more fingers stay in a flexed position with very little mobility. It is a progressive condition that worsens as the tissue gets tighter and should therefore be addressed as soon as symptoms start presenting themselves. If left untreated, it advances to a point where there is also bending of fingers, known as Dupuytren’s contracture.
Typically, patients don’t report any pain. However, it leads to inconveniences as the patient is usually unable to grasp objects, open the hand fully when trying to shake someone’s hand, or placing hands in small spaces like pockets. At our plastic surgery clinic, our orthopaedic surgeons have extensive experience treating Dupuytren’s disease and other related conditions. Feel free to reach out to us for a consultation to determine the best treatment plan for you based on how the illness has progressed at the time of the medical examination.
What Causes Dupuytren’s Disease?
The causes for Dupuytren’s disease are not obvious as they range from the unknown to family history to smoking to excessive alcohol consumption to epilepsy and even diabetes. On the other hand, research shows that the condition is not exactly preventable and elderly males of European descent (more specifically Celtic and Scandinavian) are more likely to be diagnosed with it. The severity of the condition has also been reported to be more severe in patients with a family history of Dupuytren’s contracture and less severe if it’s associated with diabetes or some specific medications.
Consultation and Diagnosis
When you walk into our plastic surgery UK clinic presenting symptoms of Dupuytren’s disease, our surgeon will examine your hand to estimate the level of progression of the disease. A nodule in the hand indicates that the disease is still in the early stage, while cords pulling at the ring and little fingers indicates an advanced stage of the condition.
The diagnosis is mostly straightforward as the doctor will simply need to physically examine both hands for signs of puckering, tethering, and pitting on the inside of the palm. Since the condition may be mistaken for trigger finger, if there is bending of the fingers, our surgeons always ask as many questions as possible as they do a thorough hand examination. One thing that stands out in Dupuytren’s disease is the nodules and lumps at the base of the finger that don’t appear in the trigger finger condition.
Treatment and Recovery
When it comes to treating Dupuytren’s disease, the condition is not exactly curable. However, there are effective treatments that have been used to slow the disease progression and temporarily solve the mobility problems. One such treatment is collagenase – an enzyme injected into the palm to eat away at the collagen in the nodules and cords causing the contracture and other symptoms.
But then, given that the collagenase breaks down the tissue indiscriminately, it may end up destroying some tendons, nerves, and blood vessels around the affected area. So, after going over the risk-benefit analysis with the patient, our surgeon may recommend surgery to release the contracture.
One way to release the contracture is to numb the palm at the base of the fingers, cut the fibrous cord, and straighten the bent fingers. Another way is to make an incision where the nodules are cut through, isolating the nerves and blood vessels and removing the buildup tissue (fasciectomy). This decreases the chances of a reoccurrence.
Patients who actively use their hands may have to take a break of about 6 to 12 weeks from work. Otherwise, 1 to 2 weeks is enough time for the incision to heal well. The doctor will advise on any changes that would be needed in prescriptions or how soon you can resume current medications.