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Dupuytren’s Disease
Dupuytren’s disease is an abnormal thickening of the fascia (the
tissue just beneath the skin of the palm). It often starts with firm
lumps in the palm. In some patients, firm cords will develop beneath
the skin, stretching from the palm into the fingers (see Figure 1). Gradually,
these cords may cause the fingers to bend into the palm (see Figure 2).
Although the skin may become involved in the process, the deeper structures—such
as the tendons—are not directly involved. Occasionally, the disease
will cause thickening on top of the finger knuckles (knuckle pads), or
nodules or cords within the soles of the feet (plantar fibromatosis).
The cause of Dupuytren’s disease is unknown but may be associated
with certain biochemical factors within the involved fascia. The problem
is more common in men over age 40 and in people of northern European
descent. There is no proven evidence that hand injuries or specific occupational
exposures lead to a higher risk of developing Dupuytren’s disease.
Symptoms
of Dupuytren’s disease usually include
a small lump or series of lumps and pits within the palm. The lumps
are generally firm and adherent to the skin. Gradually a cord may develop,
extending from the palm into one or more fingers, with the ring and
little fingers most commonly affected. These cords may be mistaken
for tendons, but they actually lie between the skin and the tendons.
In many cases, both hands are affected, although the degree of involvement
may vary.
The initial nodules may produce discomfort that usually
resolves, but Dupuytren’s disease is not typically painful. The
disease may first be noticed because of difficulty placing the hand
flat on an even surface, such as a tabletop (see Figure 3). As the
fingers are drawn into the palm, one may notice increasing difficulty
with activities such as washing, wearing gloves, shaking hands, and
putting hands into pockets. Progression is unpredictable. Some individuals
will have only small lumps or cords while others will develop severely
bent fingers. More severe disease often occurs with an earlier age
of onset.
In
some cases, only observation is needed for nodules and cords that are
not contracted. Patients with more advanced contractures may require
surgery in order to improve function.
Various surgical techniques are available in order to correct finger
position. Your treating surgeon will discuss the method most appropriate
for your condition based upon the stage of the disease and the joints
involved (see Figure 4). The goal of surgery is to improve finger position
and thereby hand function. Despite surgery, the disease process may recur
and the fingers may begin to bend into the palm once again. Before surgery,
your treating surgeon will discuss realistic goals and results.
- The presence of a lump in the palm does not mean that surgery is
required or that the disease will progress.
- Correction of finger position is best accomplished with milder contractures
and contractures that affect the base of the finger. Complete correction
sometimes can not be attained, especially of the middle and end joints
in the finger.
- Skin grafts are sometimes required to cover open areas
in the fingers if the skin is deficient.
- The nerves that provide feeling
to the fingertips are often intertwined with the cords.
- Splinting and hand therapy are often required after surgery in order
to maximize and maintain the improvement in finger position and function.
Dupuytrens disease may present as a small lump, pit, or thickened
cord in the palm of the hand
In advanced cases, a cord may extend into the finger and bend
it into the palm
Table Top Test
Treatment Diagram
© 2007 American Society for Surgery of the Hand
Developed by the ASSH Public Education Committee
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