Dupuytren's Disease Fundamentals
Dupuytren’s Disease is a condition that produces bumps or nodules on the palm. The most common place for the nodule is near the last crease in the palm, close to the base of the finger. The most common fingers involved are the ring and small fingers. The beginning of the condition is often unnoticed, but occasionally the nodules may be mildly tender.
As the disease progresses, other nodules may develop together with small indentations or "pits." With further advancement the disease spreads from the nodules to the fingers. These extensions are called cords and can cause the fingers to bend into the palm, making it difficult or even impossible for them to be fully straightened.
The disease usually progresses slowly, although the rate can vary. In rare situations, rapid progression can occur over a period of weeks or months. Pain is not associated with the worsening of the disease; however, patients may experience difficulty with activities that require the fingers to be straight – such as clapping, putting on gloves and inserting hands into pockets.
What causes the Dupuytren's Disease?
Dupuytren’s disease is believed to be hereditary, though approximately only one patient out of four identifies a relative who has the disease. The disease occurs six times more frequently in men than in women and has the highest incidence in people with European backgrounds. However, Dupuytren’s disease has now been found in virtually all races and ethnic backgrounds. Twenty percent or fewer of individuals have a severe form of Dupuytren’s disease characterized by nodules and cords on the bottom of their feet, thickening over the tops of the finger joints (known as knuckle pads), or early onset of the disease. The disease usually occurs after age 40.
What are the treatment options?
Orthopaedic surgery may worsen mild cases of Dupuytren's disease, and is not recommended for patients with early palmar nodules. However, surgery can be effective in more advanced cases.
What are the benefits of surgical treatment?
Surgery removes the abnormal tissue from the palm and fingers. The aim is to treat the contractures by excising the cords.
What are the risks of treatment?
Due to the nature of Dupuytren’s disease, the condition always recurs but usually to a minor degree. A patient who appears healthy at the time of surgery can become “diseased” later on and experience a recurrence of the problem.
As mentioned above, orthopaedic surgery may cause minor cases of Dupuytren's disease to worsen. While treatment for more advanced cases is highly successful, there is risk of damage to neurovascular structures due to changes in anatomy caused by the disease.