Dupuytren’s disease is thickening of a soft tissue in the hand called fascia. Fascia covers our body under the skin and fat. In Dupuytren’s, the normal fascia of the hand thickens and is turned to a what is called a pathological cord and/or nodule. There are several different types of cords. As a result, Dupuytren’s nodules and/or cords form in the palm and fingers leading to painless bending of the small joints of the fingers.
The main cause of this is genetic, but it is associated with other conditions and environmental factors.
What are the symptoms of Dupuytren’s contracture?
The main symptom is thickening of the soft tissues in the palm of the hand and fingers. As the condition progresses, these cords cause bending of the small joints of the hand. This is typically painless, but often restricts the ability of the fingers to straighten fully. As a result of this progressive bending of the fingers, doing many simple activities can be made difficult or in latter stages, impossible. These include reaching out to grip objects, putting on gloves and patients often describe frequently catching their fingers on objects and clothing.
How do you diagnose Dupuytren’s contracture?
The diagnosis is generally made on clinical examination, however in some patients soft tissue imaging with an ultrasound or MRI scan may be required to confirm the diagnosis.
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How do you treat Dupuytren’s contracture?
Due to its progressive nature, non-operative treatment is generally only used in the early stages of the condition. Hand therapy is the mainstay of this.
Once nodules and cords have become established and contractures of the small joints of the hand have begun, surgical intervention may be recommended in cases where the contractures interfere with daily activity. The operation I generally recommend is called a Dupuytren’s fasciectomy. In this operation the pathological, thickened cords are excised and the small joints are manipulated to get them straight. This may not always be possible, particularly in more advanced disease. It is typically done under a general anaesthetic as a day case procedure and takes between 20 and 45 minutes.