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.
How do I prepare for surgery?
Always ask your surgeon for complete pre-operative preparation instructions. Typically, these may include:
- Complete any pre-operative tests or lab work prescribed by your doctor.
- Arrange to have someone drive you home from the hospital.
- Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
- Call the appropriate surgery center to verify your appointment time.
- Refrain from eating or drinking anything after midnight the night before surgery.
Are there exercises that I can start now prior to orthopaedic surgery?
There is no specific therapy that can improve the contractures related to Dupuytren’s disease. There is also no therapy that can prevent Dupuytren’s disease from progressing.
What do I need to do the day of surgery?
- If you currently take any medications, take them the day of your surgery with just a sip of water.
- Refrain from taking diabetic pills or insulin.
- Do not wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
- Leave valuables and money at home.
- Wear loose-fitting, comfortable clothing.
What happens during surgery?
Surgical treatment of Dupuytren's disease takes place in the operating room. A regional anesthetic is commonly used, in which case the arm is "numbed" and the patient is sedated. The patient lies on their back on the operating room table with their arm out to the side on a separate table. A tourniquet is placed on the arm close to the shoulder to eliminate bleeding during the procedure. The arm is cleaned and then draped sterilely. The patient is not able to see the operation. A series of incisions are made based on the pattern of the diseased tissue, and once the tissue has been removed, the wounds are closed with a series of sutures. A below-elbow splint is then applied, holding the operated-upon fingers straight. Generally the anesthetic wears off in six to eight hours, at which point feeling begins to return, which is followed by pain. The patient is told to take a narcotic pain medicine prior to the pain actually beginning. The other critical component of pain relief is elevation of the hand above the level of the heart, which allows gravity to diminish swelling. Compared to other similar operations, this procedure is one of the least painful.
What happens after surgery?
The patient’s first post-operative visit is three to seven days after the operation. At that time therapy will be initiated by a therapist. A splint will be fabricated holding the fingers straight to prevent joint contracture. A range-of-motion program will also be initiated. One week later the suture will be removed, and a program of scar massage, using silicone sheets or scar conformers will likely be utilized at night. Specific adjustments regarding splint use and range-of-motion exercises will be made throughout the post-operative period. Generally, hand therapy is required for a period of six to 12 weeks, and home therapy is necessary for another one to two months.
How can I manage at home during recovery from the procedure?
A non-removable splint is used only for a few days. After that the splint can be removed for minor daily activities. Generally, help at home is not required but will aid in recovery. By three to four weeks patients are usually well on their way to recovery. Depending on the severity of the disease and the required surgical treatments, some individuals may return to sports such as golf by four to six weeks after surgery.
How frequently should I schedule follow up appointments with my doctor following surgery?
Patients are seen at three- to four-week intervals after the sutures have been removed. The last follow up visit is generally three months after surgery.
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