Dupuytren’s Disease

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Background

Dupuytren's disease is a chronic disorder that affects the fascia in the palm of the hand. It involves thickening and tightening of the fascia, which can pull the fingers down into the palm, leading to what is called a Dupuytren’s contracture, affecting mobility and function.

Causes

The development of a Dupuytren contracture is multifactorial. Risk factors include:

  • Genetics: Northern European descent, family predisposition
  • Age: often above 50
  • Lifestyle: smoking and use of alcohol
  • Sex: male predisposition
  • Diabetes
  • Trauma: in some patients a distinct trauma may precipitate the development of this condition. On occasion, a surgical intervention on the patient’s hand can precipitate the development of a contracture.

Symptoms

The first sign of Dupuytren's disease is the formation of nodules, cords and pitting under the surface of the palm skin. A Dupuytren's contracture may gradually develop, drawing the fingers into the palm and restricting their motion. The nodules and cords are usually, but not always, painless.

Diagnosis & Treatment

The physical examination usually allows the clinician to make the diagnosis. The involved parts of the hand are carefully inspected, including joint position and presence of any contractures. The condition is only treated if there is evidence of joint contractures, and less commonly if the nodules are prominent enough to be bothersome. Nonsurgical options include steroid or XiaflexⓇ injections. Operative procedures include needle release (percutaneous needle aponeurotomy), limited open release (fasciotomy), and excision (fasciectomy).

A personalized approach

Depending on the severity of the condition, quality of the overlying skin, and prior attempted interventions, additional measures can be considered. These include but are not limited to:

  • use of skin grafts
  • use of artificial skin / skin substitutes
  • use of flaps, either pedicled or free
  • use of dynamic external fixators such as Digit Widget ®

No two patients with Dupuytren contractures are the same. Dr. Dowlatshahi will try to offer his opinion as to the options in your particular case.

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