Dupuytren’s Disease

Dupuytren’s disease used to be known as Viking’s disease since it is most commonly seen in patients of Scandinavian and Northern European decent. Patients tend to be fair-skinned. Sometimes there is a family history of Dupuytren’s disease. The penis and soles of the feet may also rarely be effected. Dupuytren’s disease is an abnormal thickening of a normal layer of the hand below the skin known as the palmar fascia. Although extensively studied, the exact cause of Dupuytren’s disease is unknown. Sometimes a history of a previous injury, alcohol use, and use of certain seizure medications have been implicated.

Your palm contains a tough fibrous layer of tissue called the palmar fascia. This forms a protective barrier between your skin and tendons (tissue that connects muscle to bone). The fascia gives your palm a flexible firmness. For reasons not fully known, the palmar fascia can thicken. When this happens, it contracts (pulls in). Small hard knots called nodules may form just under the skin, near the base of the fingers. Hard bands also may form across the palm. Nodules, bands, and the contracting palmar fascia can make your fingers (especially the ring and little fingers) bend towards your palm.

Symptoms most often appear in 50 to 60 year old men, although women can experience this problem as well. Dupuytren’s disease can make simple tasks difficult, such as shaking hands, washing your face, or putting your hand in your pocket. Dupuytren’s disease starts slowly with thickening and nodule formation in the palm. These symptoms then can steadily progress, although they may also stop before they limit hand use. The disease is rarely painful. Signs and symptoms include a hard lump forming on your palm, inability to place your palm flat on a surface, scar-like bands forming across your palm, and inability to fully straighten your fingers.

The only way to treat Dupuytren’s disease is surgery, although experimentation is being done with injectable medications. Surgery is by no means a cure. Symptoms can recur in a few years, if not in the same site of the hand, then at other sites in the same hand. However, surgery helps many patients regain a better range of finger motion and most patients are predictably satisfied. Surgery is performed under general anesthesia, in an operating room, as an outpatient. The abnormal thickened fascia is removed, and the fingers straightened. Usually a series of zigzag shaped incisions are made. Sometimes the wounds are purposefully left open and allowed to close on their own. A splint to keep the finger straight is usually required for several weeks following the surgery, and then at night possibly for several months.

As with most other hand surgery procedures performed in our office, we strongly believe that the services of a certified occupational hand therapist are necessary to ensure a good result. This is why we have such a hand therapist on site in our office. Following surgery, you will be in a bulky dressing and splint. Sutures are gradually removed over the next several weeks. Complications include stiff fingers with loss of motion, thick scarring on the palm, numbness in the hand, injury to adjacent structures, swelling around finger joints, incomplete correction, and impaired blood flow to the hand.