Dupuytren’s disease is a condition where the connective tissue in the palm and fingers thickens and tightens, causing the fingers to bend towards the palm. This usually painless thickening can make it increasingly difficult to fully extend the fingers. The most affected fingers are the ring and little fingers, which may bend significantly in severe cases. Dupuytren’s disease is more common in Caucasians, particularly those of Northern European descent, and is more prevalent in men.
Dupuytren’s disease is not categorized into distinct “types,” but it presents with varying degrees of severity:
The exact cause of Dupuytren’s disease remains unknown, but it is strongly associated with genetic factors. The condition tends to run in families, particularly among individuals of Northern European descent. There is no definitive evidence linking the condition to injuries or excessive hand use, it is generally not considered to be caused by trauma or repetitive strain. Some people may have a “Dupuytren’s Diathesis” and have similar thickenings of fibrous tissue in their feet (Lederhosen’s disease) and genitals (Peyronie’s Disease).
Symptoms develop gradually and include:
Understanding Dupuytren’s Disease involves knowing a bit about hand anatomy. The palmar fascia is the connective tissue in the palm that thickens in this condition. This tissue is located just beneath the skin and above the tendons that help move the fingers. In Dupuytren’s Disease, this tissue becomes abnormally thick and fibrous, forming nodules and cords that restrict finger movement. The flexor tendons are responsible for bending the fingers, but when the fibrous cords contract, they pull the fingers inward, reducing their range of motion. As the condition progresses, it can significantly affect the function of the fingers and hand.
In the early stages of Dupuytren’s disease or when symptoms are mild, non-surgical treatments may be appropriate:
Surgery is considered when Dupuytren’s disease significantly impacts hand function or when the contracture becomes severe. Surgical guidelines consider intervention when there is a 30-degree contracture of the MCP joint or any contracture of the PIP joint. Functional difficulties are the main reason for opting for surgery.
Recurrence
Recurrence of Dupuytren’s disease is common, but it may not always be clinically significant. Even after successful treatment, the condition can return. This is more common in younger patients, females, Dupuytren’s diathesis and those with more significant disease. In some cases, additional surgery may be required if the disease progresses or recurs.
Post-operative recovery from Dupuytren’s surgery typically includes:
These notes have been prepared by orthopaedic surgeons at OrthoSport Victoria. They are a general overview and reflect their views, opinions and recommendations. The contents are provided for information and education purposes only and not for the purpose of rendering medical advice. Please seek the advice of your surgeon or other health care provider with any questions regarding medical conditions and treatment.
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