Dupuytren's Disease

What is Dupuytren's Disease?

Dupuytren's disease is a slow process of thickening of the thick gristle (fascia) that covers the hand under the skin. It is normally seen in people over 40 years of age and is more common in males than females. It is associated with people of northern European descent, but the cause/reason is unknown. It usually starts with a lump or pit forming in the palm of the hand, over time thick fibrous bands form longitudinally in the palm up to the fingers or thumb, these eventually lead to the fingers being pulled down toward the palm.

Patients tend to complain of being unable to put the palm flat on a table or straighten the fingers. They often have difficulty with some activities and occasionally will report that they are poking themselves in the eye when washing their face or are unable to get their gloves on in the winter.

Management

If the fingers are causing you bother and you visit your GP he or she may refer you to see the orthopaedic team at the hospital.

The orthopaedic clinician will then assess your condition, firstly ensuring that it is Dupuytren's and then assessing how well surgery will help and discussing with you the appropriateness of surgery.

Unfortunately conservative management of Dupuytren's, such as medication or physiotherapy, has no effect on the course of the disease and for patients who are finding the condition a bother surgery is the only effective management.

Surgical treatment

Needle fasciotomy

Needle fasciotomy is carried out in our outpatient clinic. It involves inserting a blade or needle into the palm or fingers under local anaesthetic and then using it to cut through the bands of tough connective tissue. The procedure doesn't cure Dupuytren's contracture. The aim is to stop the problem from getting worse and to help the patient regain the use of their hand. Once this procedure has been carried out you will be booked to see Suzette Botha the Hand Therapist within 48 hours for a splint and exercise advice, or on the same day if pre booked. You should be back to normal activities within 5-7 days and driving within 2-3 days.

Studies have showed that the procedure improved patients' ability to stretch their fingers in the short term. After 3 to 5 years, the problem had returned in about half of the patients treated. It appeared that the procedure was more likely to be successful in patients with less severe tightening and/or where the tightening was across the finger joints.

One expert said that patients who had needle fasciotomy felt more benefit, and recovered more quickly than people who had open surgery for Dupuytren's contracture, even though the effects of needle fasciotomy weren't likely to last as long as the effects of open surgery.

In the studies, the skin of some patients split following the procedure. Some patients found the procedure painful, and some patients had nerve damage in their hands as a result of the procedure. The experts said that the main problems with needle fasciotomy were nerve damage, damage to the tendons in the hand, and infection. One of the experts said that problems were rare, and were likely to affect fewer than 1 person in 100. (NICE guidelines).

Full Fasciotomy

Mostly day case but under general anaesthetic, you may or may not need to attend physiotherapy or have to wear a splint after the operation. This will be discussed with you before or after your surgery.

The goal of surgery is to restore the use of the fingers.

Considerations

Surgery may not be a permanent cure for this disease. After surgery, thickening of the palm and development of the band may return in the same place, or at a new place within the hand

Surgery may not completely relieve bending of the fingers at the joints in the fingers if the joints have become fixed over time.

May have 6 weeks in splint/night splint all the time

May require 6 months of night time splintage

Unable to drive for about 4 wks depending on wound healing

Possible problems

Unable to correct deformity.

Deformity recurs in that finger or another place.

Often a raw area where we cannot close the skin: takes 3 weeks or so to heal.

Can have permanent numbness on finger tip, because nerve gets tangled up in Dupuytren's tissue.