Click on each question to learn more:
What is Dupuytren's disease?
What are the clinical symptoms of Dupuytren's Disease?
Who gets Dupuytren's Disease (DD)?
What causes Dupuytren's Disease?
What is the treatment for Dupuytren's Disease?
What is the recovery from Needle Aponeurotomy like?
What is the recovery from Open Surgery like?
What is the recovery from Xiaflex™ collagenase injection like?
What is the recovery from Radiotherapy like?
Dupuytren's disease causes bending, or contraction, of the fingers into the palm, as well as the formation of pits, cords, and nodules in the palm and fingers. It is a progressive, genetic condition of the skin and fascia (the tissue between the skin and the tendons in the palm) and occurs most often in the ring and small fingers. Dupuytren's is a genetic condition that affects men much more than women, particularly men of Northern European descent, often beginning in their 40's.
The condition occurs very slowly and often begins with a firm and generally non-painful, non-cancerous nodule in the palm of your hand. The nodule may extend to become a rope-like cord that will gradually contract, drawing the fingers into the palm. For many people this occurs over years, though for some it progresses more rapidly.
Dupuytren's Disease occurs most often in the ring and small fingers. Intervention should be considered if you cannot place your hand flat onto a table top as shown—this is the "table top test."
Evidence does not support that manual labor either hastens the onset or the progress of an existing disease.
The cause of Dupuytren's remains a mystery. Dupuytren's disease affects the connective tissues between the skin and the tendons in the palm. This connective tissue is made up of cells called fibroblasts. Myofibroblasts are fibroblasts that take on the characteristics of smooth muscle cells. These cells act like slowly contracting rubber bands, pulling the fingers in toward the palm over time.
Treatment is initiated when you fail the “table top test” or if there is a contracture of the finger of about 15-30°.
Currently there are 4 treatment options:
Needle Aponeurotomy is a non-invasive procedure performed in the office. You leave with a few small band aids and are able to perform any and all activities right away, though we ask you to refrain from grasping activities for a week. Therapy and splints are a rarity.
More than anything else, recovery requires a time commitment of weeks to months in combination with dedicated therapy with a knowledgeable hand therapist.
Immediately after and in the months following surgery, a splint is used to maintain a straight finger.
Each finger involved may require up to three (3) injections 30 days apart. During research evaluations, often only one injection was required. The day after injection you return to the office for a manipulation to break the cord. The hand and fingers are numbed for this. Swelling and bruising are common after the injection. Insurance approval is required as this medication is still relatively new, having been available since March 2010.
Radiotherapy is more common in Europe, particularly Germany. It is performed by a radiation specialist and is intended for early disease before contractures have occurred. Some patients get skin irritation from the treatment.