Also known as Dupuytren’s disease, is a benign (non-cancerous) condition of the hands. It can present as dimpling, thickening or tenderness of the palms of your hands and as it develops small lumps (nodules) can form. It can affect one or both hands predominately
affecting the fourth, third and fifth finger.
It happens due to the increased proliferation rate of some cells called fibroblasts and myofibroblasts. While symptoms are often mild and painless, the cording can harden over time causing your fingers to curl inwards. This contracture can make it difficult to straighten them and as a result certain tasks such as playing musical instruments, swimming or shaking hands can become difficult.
Early diagnosis of Dupuytren’s can provide you with additional treatment options.
The main treatments used in the UK for the differing stages of disease are:
Watch and wait: In some cases the disease may not lead to a contracture of the fingers.
Radiotherapy: Can be most effective during the earlier stages of the disease, when nodules are growing and cording is developing with slight contracture. It has shown promising results at halting or slowing any progression of the disease and is a non-invasive treatment
option with minimal side effects.
Needle aponeurotomy: A doctor uses a needle to cut the cord/s causing the contraction. This can usually be performed as an outpatient procedure and is less invasive than a surgical procedure, resulting in a quicker recovery time. The rate of recurrence of contracture is 50% although this procedure can be repeated and this is usually necessary within three to five years of the first procedure.
Collagenese injections: An injection into the cords of collagenase enzyme should dissolve and weaken the cord sufficiently to allow the fingers to be straightened.
Surgery: This is most favourable as an option when your finger is bent at the MCP joint by more than 40% and/or when the PIP joint is bent by 20%.
The surgeon will discuss the most appropriate surgical procedure with you and there will be a period of recovery time following surgery, with the need for additional hand therapy
Radiotherapy is a quick and painless treatment that may be beneficial in the early stages of the disease. Testimonials from patients who have received the treatment can be found at www.dupuytrens-society.org.uk
The course of treatment is short, happening over the course of five days with the option of it being repeated after six weeks if necessary. Treatment appointments last 30 minutes and are done on an outpatient basis. Short and long term treatment side effects are minimal due to the low dose that is prescribed and, while all radiation carries some degree of risk to health, in this case the risks are extremely low. Any side effects that may occur are usually short term and can include tanning of the skin, dryness, redness and some soreness similar to sunburn.
Radiotherapy is a non-invasive and pain free treatment, requiring little rehabilitation after treatment. Having radiotherapy does not prevent you from pursuing other treatment options in the future if this is necessary. Currently radiotherapy for Dupuytren’s is predominantly available in private clinics.