posted 15 ^th Mar 2019

Dupuytren’s disease, also known as Dupuytren's contracture, is a relatively common condition that usually arises in middle-age, or later, and affects more men than women.

The cause of the disease is still unknown, however the highest rates are experienced in Northern Europe, this is why Dupruytren’s is known as “Viking's disease”, and it often runs in families.

Dupuytren's may be associated with Diabetes, smoking and high alcohol consumption, Epilepsy and some medications. However, many affected people don’t fit this profile and the cause is unknown. There is also no proven direct causal link with manual work. It can occasionally appear after an injury to the hand or wrist, or after surgery to the hand for  another condition. The trauma associated with the injury or surgery, seems to aggravate  the disease and cause it to develop.

Signs

Dupuytren's starts with nodules in the palm, often in-line with the ring finger. The nodules are sometimes uncomfortable when pressure is applied in the early stages, but the discomfort generally improves over time.

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 can be experienced by some people with Dupuytren's disease.

With time, the nodules usually extend to form cords that pull the finger towards the palm and prevent it from straightening fully. Without treatment, one or more fingers may become fixed in a bent position. The web between thumb and index finger is sometimes narrowed. Contracture of fingers is usually slow, occurring over months and years rather than weeks. As the deformity develops, the sufferer will notice that they are unable to place their hand/s flat on a table, fit their hand/s in a pocket and can catch their eye with the bent little finger when washing their face.

Treatment

Although there is no cure, there are interventions that can usually make bent fingers straighter. In people that can fully straighten their fingers, surgery is not necessary, however it is likely to be helpful when it has become impossible to put the hand flat on a table, and should be discussed with an expert Hand and Wrist Consultant at this stage.

The surgeon will be able to advise on the treatment best suited to the individual. The options include either a small needle release or an injection of an enzyme to dissolve the cord, both done in an Outpatient Department. If this is not suitable, or has already been performed and the cord returns, surgery is usually effective in removing the cord. This procedure can now be easily performed under local anaesthetic.
 
Mr Mike Hayton is a Consultant Orthopaedic Surgeon specialising in treatment of the hand, wrist and elbow at Wrightington Hospital.

 

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