What is Dupuytren’s disease?
Dupuytren’s disease or Dupuytren’s contracture is when the tissue in your palm and the front of your fingers becomes thick and cord-like, causing one or more fingers to bend towards your palm. Nodules and long cords form beneath the skin in your hand. These are hard and inflexible, so you can’t straighten one or more of your fingers. Eventually your fingers bend towards the palm of your hand, which can limit what you can do at home and work. It is a common condition affecting around 7% of the population over 70 in Australia, although can occur at any age. It’s six times more common in men than women, and more prevalent in older people and those of Northern European descent. There’s no cure for the condition, however it can be managed.
Causes
The exact cause of Dupuytren’s disease is still unknown, although several factors have been associated with an increased risk of developing the condition. These include a family history of Dupuytren’s disease, the use of vibrating hand tools, diabetes or epilepsy, excessive alcohol consumption, smoking, and previous injury or surgery to the hand or wrist. However, some people may develop Dupuytren’s disease without having any of these risk factors.
Symptoms
A lump or nodule on the palm of your hand(s) which may be painful –normally towards the fourth or fifth fingers
You may also notice skin texture changes with small pits in the palm
You may have hard cords in your palms which appear to grow from a nodule and pull your fingers towards your palm – at this stage, you may start to have difficulty using your hand.
Diagnosis
Your surgeon will discuss your symptoms with you and perform a medical examination, including the ‘table top test’ which is a simple test to try and evaluate the severity of the disease. Your will be asked to place your hand flat on the table. If you are unable to do so then it is likely that you might need surgery to treat the disease in the future.
Imaging
No imaging is required to make the diagnosis. It is made by taking a history and clinical assessment.
Treatment
Conservative (Non-operative)
Conservative treatment of Dupuytren’s disease is generally aimed at monitoring symptoms, maintaining hand function, and managing discomfort, particularly in the early stages when finger contractures are mild and hand function is not significantly affected. Treatment may include observation and regular review to assess progression, as some cases remain stable for long periods. Activity modification and ergonomic adjustments can help reduce strain on the hand during daily tasks. Physiotherapy or hand therapy may be recommended to maintain finger mobility, improve hand function, and provide education on stretching and splinting techniques, although splinting alone has limited evidence for preventing progression. Pain or inflammation, when present, may be managed with nonsteroidal anti-inflammatory drugs (NSAIDs). Conservative management is often appropriate until the deformity begins to interfere with hand function, at which point procedural or surgical treatment may be considered.
Surgical treatment
Surgical options for Dupuytren’s disease may include percutaneous needle fasciotomy or surgical fasciectomy, depending on the severity of the condition. Percutaneous needle fasciotomy is a minimally invasive procedure performed under local anaesthetic, where a small needle is used to divide the diseased cords through tiny puncture sites before the finger is gently manipulated to improve movement. In more advanced cases, a fasciectomy may be performed as a day procedure under local anaesthetic with sedation or general anaesthetic. This involves making zigzag incisions in the palm and affected fingers to carefully remove the diseased tissue while protecting nearby nerves and blood vessels. In severe cases, a skin graft from the forearm may be required. Following surgery the hand is immobilised in a bulky dressing and splint before transitioning to a removable splint during recovery.
Recovery
This depends on the type of treatment you’ve had, but can take from between 2 and 6 weeks (and up to 3 months in severe cases). Your surgeon and hand therapist will be able to advise you on this.
When can I return to normal activities?
- Work – this depends on your individual employment, however if your job mainly involves office/sitting then you may be able to return within a few days. If you have a more active role , your surgeon will be able to advise you on a suitable period of time, however it could take up to six weeks.
- Driving – the hand needs to have full control of the steering wheel in case of emergency. Return to safe control of a vehicle varies between individuals.
- Exercise – Once the wounds are dry you can start cardiovascular exercise, usually not before 14 days. It may be several weeks before you can use your hand for weight training and gripping type activities.