By Caroline R. Triepel, M.D.
Imagine how challenging activities of daily living might be if your fingers curled toward the palm of your hand causing your hand to be immobile or less functional. Activities requiring manual dexterity—like wrapping your hand around a car’s steering wheel or even washing dishes—would be increasingly difficult for the person with the disease known as Dupuytren’s (du-pra-tranz) contracture. What is Dupuytren’s Contracture?
Dupuytren's contracture is a condition where the connective tissue that lies beneath the skin in the palm of the hand tightens into a “cord”. What begins as a small knot or painless lump at the base of the ring, little or middle fingers over time may impair the function of the hand as the contracture pulls the finger or fingers toward the palm. This results in losing the ability to fully open or flatten the hand. Interestingly, the index finger and thumb are seldom involved in this condition. What are the Causes?
No one really knows what causes Dupuytren's contracture, but it is well known that it runs in families. People of northern European descent—Scandinavia, England, Scotland and Wales—have the highest incidence. And it is about seven times higher among men than among women.
Most of the time, the disease doesn’t show up until after age 40. However, a very aggressive form may rarely appear in teenagers and children
Other factors have been suspected for causing Dupuytren's, such as trauma, diabetes, alcoholism, epilepsy, and liver disease, but there is no clear relationship. Once a patient develops it there is no diet or exercise that will inhibit it. What are the Treatment Options?
In mild cases, especially if hand function is not affected, only observation is needed. If the disease gets worse over time that makes everyday activities such as picking up items, putting on gloves or washing hands difficult or impossible, then other treatment options may be considered.
One method is surgical removal (fasciectomy) of the “cord” of hardened connective tissue in the palm to restore some function to the hand. The disadvantage of this procedure is the lengthy recovery time and greater risk of injury to nerves or arteries in the hand.
A more recent, less invasive approach divides the “cords” but does not remove them. Using a needle to sweep and cut the cord (fasciotomy) is an alternative that requires no incisions and can be performed under local anesthesia in the physician’s office. Recovery is usually quicker as well.
Another newer treatment involves the injection of an enzyme called collagenase directly into the “cord”. After the injection, the finger is straightened in the office under local anesthesia the next day.
While all three treatments should be considered, it’s important to know therapy and splinting is an integral part of the rehabilitative process to maximize the straightening of the fingers and the function of the hand. Despite treatments, the disease process may recur in adjoining hand tissue or when the less invasive treatments are employed as opposed to the more invasive fascietomy treatment.
If you think you may have Dupuytren’s disease, the first step is to make an appointment with a hand surgeon specially trained to help you evaluate treatments that provide you with the best knowledge of all options to treat Duputryen’s disease. Hand health is an important dimension of maximizing your physical health.
Photos below are before and after treatment for Dupuytren’s Disease.
Caroline R. Triepel, M.D. is a board certified and fellowship trained hand surgeon practicing with Sentara Hand Surgery Specialists
—a Sentara Medical Group. She received her medical degree at the University of Virginia followed by general surgery and orthopedic residencies at Wake Forest University Medical Center in North Carolina. Dr. Triepel completed a Hand and Upper Extremity Fellowship at Tufts University School of Medicine in Boston MA prior to beginning her practice in the Hampton Roads area.
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