Dupuytren’s disease is an abnormal thickening of the fascia (the tissue between the skin and the tendons in the palm) that may limit movement of one or more fingers. In some patients, a cord forms beneath the skin that stretches from the palm into the fingers. The cord can cause the fingers to bend into the palm so they cannot be fully straightened. Sometimes, the disease will cause thickening over the knuckles of the finger. It can also occur in the soles of the feet.
The cause of Dupuytren’s is unknown and there is no permanent cure. The disease is usually painless. This is a non-cancerous condition. Dupuytren’s disease mostly affects white people with ancestors from Northern Europe. It occurs more often in men than in women, and usually starts after age 40. In many cases, the disease runs in families. It is also associated with excess alcohol consumption, diabetes and liver disease.
Symptoms of Dupuytren’s Disease
Dupuytren’s disease occurs slowly. It is usually noticed as a small lump or pit in the palm. This tends to occur near the crease of the hand that is closest to the base of the ring and little fingers. With time, a cord may develop between the palm and the fingers.
The disease is usually noticed when the palm of the hand cannot be placed flat on an even surface, such as a table top. In severe cases, drawing of the fingers into the palm interferes with everyday activities, such as hand washing, wearing gloves and putting hands in pockets.
Treatment of Dupuytren’s Disease
Small tender nodules in the palm may respond well to a steroid injection.
Surgery can relieve the bending of the fingers into the palm, but it is important to appreciate that there is no guaranteed permanent cure for Dupuytren’s disease and the condition may return with time. The goal of surgery for Dupuytren’s disease is to restore the use of the fingers.
The presence of the lump in the palm of hand does not necessarily mean that surgery is required. Bending of the fingers into the palm at the base of the fingers is usually correctable by surgery. There are a range of surgical procedures available including operations to simply divide the Dupuytren’s band of tissue (fasciotomy), cut out the tissue (fasciectomy), and to remove both the Dupuytren’s tissue and the overlying skin (dermofasciectomy), in which case a skin graft would also be needed to cover the open area. Surgery, however, may not completely relieve bending of the fingers at the joints in the fingers.
After surgery, thickening of the palm and development of the cord may return in the same place, or at a new place within the hand. 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.