Dupuytren’s disease, also referred to as Dupuytren’s contractures, is a benign disease of the connective tissue of the palm of the hand and can lead to nodules and contractures of the fingers.

Anatomy and Causes

Dupuytren’s disease is a connective tissue disorder of the palms of the hands and fingers.  Your hand has a very complex connective tissue structure which helps hold your skin to the deeper structures of your hand while also allowing complex movement.  In the case of Dupuytren’s disease, some of this connective tissue becomes overgrown and can lead to painful nodules in the hand and thickened “cords” in the palms and fingers.  As these cords continue to thicken, the motion in the finger joints becomes limited leading to contractures of these joints.

Dupuyten’s disease has a strong genetic component, and is most common in people of Northern European descent.  Dupuytren’s disease also has a large environmental component, and trauma to the hands and fingers may spark the onset or acute worsening of it.

Symptoms and Associations

Patients with Dupuytren’s disease may notice small, firm, often painful nodules in the palm of the hand.  They may also notice tight, painless cords in their palms and fingers.  As cords thicken they begin to tether the fingers, preventing them from fully extending.  This is termed a contracture. These contractures can lead to severe disability making it difficult to use the hand.

Dupuytren’s disease can involve any of the fingers, but most frequently involves the ring finger.  The condition usually first shows up between the ages of 40 to 60.  Patients may also have similar contractures in the soles of their feet (Ledderhose disease) or in their penis (Peyronie’s disease). 

Treatment

Treatment for Dupuytren’s disease is focused on maintaining function of the hand.  At this time there is no cure for this disease, but interventions can maintain joint motion and help maintain good function of the hands.  

Non-operative

Non-operative treatment is appropriate for nodules and cords without significant joint contractures.  Non-operative treatment involves ongoing observation and stretching to maintain joint function.

Interventional

Interventional treatments for Dupuytren’s disease include office-based procedures and surgical excision of the cords.  Office based procedures are targeted at cutting specific cords to allow increased joint motion.  This can be accomplished by cutting the cord directly with the tip of a needle (needle aponeurotomy), or by injecting an enzyme into the cords to help weaken their structure before manipulating the fingers to break the cords.  Both of these procedures can be done in the office under local anesthesia.  These procedures are not appropriate for all types of cords or contractures and have a higher recurrence rate than surgical excision, but may be a good option in some cases.

Operative

Surgery for Dupuytren’s disease involves excising, or cutting out, the abnormal fascia.  This is termed a partial fasciectomy.  Surgery is performed as an outpatient procedure with no need to stay overnight in the hospital.  Interventions for Dupuytren’s disease, including the office-based interventions, include a risk of damage to the nerves in the fingers and recurrence of the problem.  There is also a risk of skin tears in fingers with severe contractures, though these rarely result in long-term issues.  Surgical management of Dupuytren’s has the lowest recurrence rate, but also has a longer recovery time compared to office-based procedures.