Dupuytren’s Contracture of the Hand
By Donald Lewis, MD
Muir Orthopaedic Specialists, Walnut Creek
Dupuytren’s disease is a benign growth that develops in the palm and fingers of your hand. It usually is present in men and women over 50 years old, but can occur at younger ages. It usually involves small nodules or firm areas of the skin that are painless, and can cause contractures at later stages. It is believed to be inherited; often there is a history of a relative with finger contractures later in life.
What causes it?
There is some association between trauma to the hand, such as surgery. Also diabetics, alcoholics, and seizure patients can have an increased incidence of Dupuytrens. It is considered hereditary but can also occur spontaneously.It is much more common later in life as we age.
Why is it called Dupuytrens?
Baron Guillame Dupuytren was a famous surgeon in Paris in the 1700’s who extensively studied this disease and recommended surgical treatment. Although he was not the first person to describe or treat the contractures, he was one of the major investigators early on.
Do I have it?
If you have firm nodules or growths in your palm and fingers, it may be Dupuytrens. It is common in Caucasians of northern European descent, and rarely occurs in anyone under 30 years of age, Asians, or African-Americans.The first sign is the presence of small nodules in the palm, which feel like hard lumps. These can grow slowly over time, and cause contractures of the fingers in later stages, especially the ring and small fingers. These are rarely painful unless actively growing. It is a benign disease and usually does not spread to other areas, although in certain individuals there can be knuckle pads on the back of the hand and growths on the sole of the foot (Ledderhose’s disease).
Do I need treatment?
Although unsightly, most people with Dupuytren’s cords in their hands need no treatment, as the problem is mostly cosmetic. If you have trouble getting your palm and fingers flat on a table secondary to contractures, which is a positive ‘table top test’, you may benefit from a procedure to improve your finger extension. If there is no contracture usually no treatment is necessary, as this is a slowly growing benign disease.
What are the treatment options?
Currently there is no known benefit to stretching, splinting, therapy, dietary changes, or medications. There is an injectable enzyme that is being used experimentally to dissolve the cords, but this is not FDA approved and is not available to the public currently.
There are two main treatments options: needle fasciotomy and open fasciectomy. Needle fasciotomy is a simple office procedure that was developed in France and involves using a needle under local anesthesia to transect the cords, allowing improved motion instantly. This has the benefit of lower cost, convenience, and quicker recovery, but has the potential downside of a higher recurrence rate. For more information on this procedure see my website dupuytrens-drlewis.com.
Open fasciectomy is a more formal surgical excision of the diseased tissue under anesthesia in the operating room. It has a higher incidence of complications such as pain and scarring, and the recovery is longer involving splinting and hand therapy. The aim of the surgery is not to remove all the abnormal tissue, but to regain motion. The advantage of this procedure is more severe cases can be treated and there may be a lower recurrence rateover the long term. This is often the best choice for recurrent contractures after previous procedures.