Dupuytren's Disease

Dupuytren Figure 1What Is It?
Dupuytren’s disease is an abnormal thickening of the fascia (the tissue between the tendons and the skin in the palm) that may limit the movement of one or more fingers. In some patients a cord forms beneath the skin that stretches from the palm to the fingers. The cord can cause the fingers to bend into the palm so they cannot be fully straightened. (see figure 1)

What Causes It?
The cause of Dupuytren’s is unknown and there is no permanent cure for it. The disease is usually painless. This is a non-cancerous condition. Dupuytren’s mainly affects white people with ancestors from Northern Europe. Injuries to the hand do not directly cause Dupuytren’s.

Signs & Symptoms
Dupuytren’s disease occurs slowly. It is usually noticed as a small lump or pit in the palm. This tends to start in the crease of the hand nearest to the base of the ring and small finger. (see figure 2) With time a cord may develop between the palm and the fingers. The disease is usually noticed when the palm can no longer be placed flat on a table. In more severe cases the fingers may be drawn into the palm.

Treatment
There is no permanent cure for Dupuytren’s disease. Surgery can relieve the bending of the fingers into the palm, but the condition can return with time. The goal of surgery for Dupuytren’s disease is to restore the use of the fingers. Your doctor should advise you on whether surgery is recommended in your case.

Dupuytren Figure 2Presence of the lump in the hand does not mean that surgery is required. Bending of the fingers into the palm at the base of the fingers is usually correctable by surgery.

The primary treatment for Dupuytren’s contracture is surgery. Dupuytren’s does not respond to medication, physical therapy, or splinting. The goal of surgery is to remove all cords that are causing contracture. Surgery may not completely relieve bending of the fingers at the joints in the fingers.

It is important to remember that surgery is not a permanent cure for this disease. After surgery, thickening of the palm and development of new cords may return in the same place, or at a new place within the hand.

Sometimes skin grafts are needed to cover open areas in the fingers. Sometimes splints are used after surgery to help keep the fingers straight.

A hand therapist may help with your postoperative care to help control swelling and to help with finger motion.