21 July 2014
Dupuytren’s disease affects over 2 million people in the country, principally those with fairer skin and anecdotally has been related to Scandinavians – “Viking disease”. The genetics of Dupuytren’s is still not properly understood. It may run in families or equally be of spontaneous onset. It’s perhaps exacerbated by excessive alcohol consumption, diabetes and possibly repetitive hand trauma over many years.
What is Dupuytren’s disease?
Dupuytren’s disease is a condition which affects the skin on the palm side of the hands. Classically it is more towards the ring and little finger starting with painful red nodules which over time can extend to form cords of excessive tissue. These can contract causing the fingers to pull into the palm which cannot be straightened even with help from the other hand.
When should you seek advice for this condition?
The time to seek advice is quite simply when the finger contracture becomes bothersome to your hand function. Classically we think this is when the joint becomes contracted by more than 20 degrees. Your GP is the best person to start with, who will examine your palm and hand for signs of the condition. If you’re unable to fully extend one of your fingers your GP may refer you to a specialist for further assessment and treatment as necessary.
Can treatment be performed in clinic, not requiring admission to hospital?
Yes, there are two simple clinic based treatments. The first is to use a needle under local anaesthetic to perform a release of the cord. Although described by an Englishman this was popularised by the French and is referred to as needle fasciotomy. The second is an enzyme injection of collagenase (Xiaflex) which can digest a small piece of the cord away allowing the contracture to be released with a manipulation manoeuvre the next day under local anaesthetic, also in the clinic environment.
Both are probably relatively similar with a slight benefit of the needle release meaning that multiple sites can be targeted in the hand. The enzyme injection however actually removes a very small piece of the cord but only one can be done at a time.
Whilst both of these treatments may appear attractive, in that they don’t involve surgery, and certainly do result in an improvement of the contracture, they are both associated with a higher recurrence rate particularly of the smaller joints of the fingers.
What about surgical treatments?
Surgical treatment to correct Dupuytren’s involves a cut in the hand under a general anaesthetic (meaning you will be asleep throughout the procedure) or arm block (where you’re unable to feel any pain or move the limb) and remove a larger piece of the cord. This is called a facsiectomy operation. Compared to treatment performed in clinic, surgical treatment offers better chance of full correction and a longer disease free interval. Dupuytren’s typically can’t really be totally cured as it is an inherent tendency of the hand to reform excessive tissue.
On the most aggressive end of the spectrum of all the treatments is dermo-fasciectomy which is to excise all the Dupuytren’s disease and skin over it, using a skin graft taken from elsewhere on the body. This has the longest rehabilitation but it is not common to see a recurrence underneath a skin graft. This skin however is never of quite the same quality as the normal palmar skin and maybe slightly more prone to injury.
Are there other treatments available?
Other treatments available include radiotherapy. This may be effective for the more earlier painful nodular phase but the long term results still haven’t been clearly described and no trial exists comparing it to surgical treatment.
Beyond this I am not aware of strong evidence that manipulations or pressing objects into the palm make a significant difference.
What are the risks associated with treating Dupuytren’s disease?
Prior to any treatment being performed, I advise all my patients of the possible complications related to both non-surgical and surgical treatments. Possible complications may include; nerve damage to the fingertips, joint stiffness, slow wound healing, infection, scarring or a blood filled swelling (haematoma) forming under the wound all of which may be rectified with appropriate advice from your surgeon. Finally, it could all come back ie recurrence!
How long does recovery take following treatment?
Patients need to be aware that rehabilitation may last up to some months before full grip strength is restored. Specialist hand therapy is usually recommended to improve the movement and function of your hand. Again, it’s important to discuss the aftercare with each patient prior to undergoing any treatment so they’re fully informed to manage their expectations following treatment.
A number of treatments exist for Dupuytren’s finger contracture when it becomes troublesome, all of which (except radiotherapy) are offered at Spire Norwich Hospital. The best advice is to have a good conversation with a surgeon who can offer a broad range of treatments thus tailoring them to your specific needs.
All surgery carries an element of risk and the content of this page is provided for general information only. It should not be treated as a substitute for the professional medical advice of your doctor or other healthcare professional.