Topic Overview
What is Dupuytren's disease?
Dupuytren's (say "duh-pwee-TRAHNZ")
disease can change how your hand looks and may make it hard or impossible to
use one or more of your fingers.
The disease causes tissue under
the skin of the palm of your hand to thicken and shorten. This can pull and
bend the fingers in toward the palm. You may not be able to straighten them.
See a picture of a hand with
Dupuytren's disease.
The disease gets
worse slowly but rarely causes pain. You can treat it, but there is no cure. It
may only involve the palm and never affect your fingers, and you may never need
treatment.
Dupuytren's disease occurs most often in people ages 50
and older. It often affects both hands and can sometimes affect the soles of
the feet.
Dupuytren's disease is also called Viking's disease.
What causes Dupuytren's disease?
The cause of Dupuytren's disease is not known. It might be inherited,
because the disease tends to happen in families. The thickening of the tissue
may be related to alcoholism, smoking, or
diabetes.
What are the symptoms?
You may first see or feel a small lump in the
palm of your hand, usually near where your ring finger and small finger
meet.
As Dupuytren's disease gets worse, a fibrous cord may
develop in the tissue of the palm. The cord may extend to one or more fingers,
usually the ring or small finger. The cord may pull your finger toward your
palm. This is called Dupuytren's contracture.
At some point you
may not be able to move your fingers back or flatten your hand on a table. You
may find it hard or impossible to do things like put on gloves, wash your
hands, or pick up things.
The disease usually does not cause pain.
If you do have pain, it’s most likely when you first get the disease.
How is Dupuytren's disease diagnosed?
Your doctor will look for skin changes on your palm and feel for any
knots or a cord. He or she will ask you to move your hand, wrist, and fingers.
Your doctor will ask you questions about your family and your symptoms. Your
doctor also will ask you about smoking and alcohol use.
How is it treated?
The goal of treatment for
Dupuytren's disease is to keep your hand working as best as it can.
- When you first get the disease, your doctor may have you try finger stretches, a splint, or steroid shots.
- Some doctors are using a treatment called needle aponeurotomy to separate the tight cords in the palm using a needle.
- A medicine called collagenase (such as Xiaflex) may be injected to try to dissolve some of the tight tissue.
- Surgery may be recommended if you cannot straighten your fingers or pick things
up.
Frequently Asked Questions
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Being diagnosed:
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Getting treatment:
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Cause
The cause of
Dupuytren's disease is unknown. Heredity is thought to
be a factor, because Dupuytren's disease tends to occur most often in people of
northern European descent and among close family members. The thickening of the
tissue between the skin and tendons, called the palmar fascia, may be related
to one or more things, such as:
Symptoms
Dupuytren's disease usually does not cause pain. When pain does occur, it often is
early in the disease or may happen if inflammation develops (tenosynovitis).
The first noticeable symptoms of Dupuytren's disease may
be:
- A small knot that may be visible or felt on the
palm, usually near the base of your ring or small fingers. The knot is
sometimes sensitive to pressure. And it may gradually thicken and begin to pull
one or more of your fingers toward the palm.
- Dimpling that appears
on the skin of your palm when the diseased tissue between the skin and tendons
(palmar fascia) pulls on the skin.
As the disease progresses, a fibrous, ropey cord may
gradually develop in the palmar fascia and connect your palm to one or more
fingers, usually the ring or small finger. The cord pulls your finger toward
the palm, which is called
Dupuytren's contracture. Eventually you will not be
able to flatten your palm on an even surface, such as a table. When it is
severe, Dupuytren's contracture can make certain everyday activities—such as
picking up items, putting on gloves, or washing your hands—difficult or
impossible.
Other conditions that may cause
symptoms similar to those caused by Dupuytren's disease include rheumatoid
arthritis and work-related injuries.
What Happens
Dupuytren's disease is often not noticed until it becomes severe. The tissue between
your skin and tendons, known as the palmar fascia, becomes abnormally thick and
fibrous. It is not yet clear what causes this thickening.
There
are three general phases of the disease:
- Early. You may notice a
small knot on the palm or at the base of the fingers. There is no pulling or
contracture between the fingers and the
palm.
- Active. Dimpling appears on the skin
of the palm due to the growth of the thickened palmar fascia. Long, ropey
cords and bands also develop in the fascia, stretching from the palm to one or
more fingers. The cord can sometimes be seen and felt.
- Advanced.
The thickened palmar fascia and cord cause a rigid, disabling
contracture when the attached finger is drawn towards
the palm. Eventually you will not be able to flatten your palm on a table or
other even surface. Very severe forms of the disease result in an inability to
do routine tasks, such as using silverware.
The disease usually progresses slowly. It most often occurs
after age 50. Many people have a mild form that does not cause significant
problems. But a rare form called Dupuytren's diathesis occurs at an early age
and progresses rapidly.
Dupuytren's disease often develops in
both hands of people with the condition, and it most commonly affects the ring
and small fingers.
What Increases Your Risk
You are at an increased risk
of developing
Dupuytren's disease if you:
- Have a family history of the disease.
- Are of northern European heritage.
- Are a male.
- Are over age 50.
You are more likely to get Dupuytren's disease if you have
certain diseases or disorders, such as
diabetes or
alcoholism. Cigarette smoking also increases your
chances of getting the disease. You may also have a slightly higher chance of
getting Dupuytren's disease if you are being treated for epilepsy.1
When To Call a Doctor
Call a doctor if you
notice:
- Dimples or knots in your palms, especially near
the base of your fingers.
- An inability to flatten your hand, palm
down, on an even surface.
- Pain in your palm or fingers.
Watchful waiting
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition
without using medical treatment. This period may vary from a few days to weeks,
months, or years.
Dupuytren's disease usually is a slowly progressing
disease.
Who to see
The following health professionals can
diagnose Dupuytren's disease:
A hand surgeon, orthopedic surgeon, or
plastic surgeon can also diagnose and treat
Dupuytren's disease. These doctors are most often seen for severe disease, when
you cannot use your hand for everyday activities.
A
physical therapist or an
occupational therapist, or both, may be part of your
treatment team and can teach you how to exercise your hand to help keep your
hand and fingers flexible.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Dupuytren's disease develops slowly and may be hard to diagnose in its early
stages. Most people do not see a doctor until the disease has
progressed. A medical history and physical exam usually provide enough
information for your doctor to determine whether you have
Dupuytren's disease.
Questions about your medical history for
Dupuytren's disease will usually include:
- Whether any close family members have been
diagnosed with Dupuytren's disease or have had any similar
symptoms.
- Your ethnic background.
- The symptoms and
signs you've experienced and for how long.
- Whether you've noticed
similar symptoms on the soles of your feet.
- Whether you've
experienced any pain in your hand.
- Whether you have a history of
smoking or
alcoholism.
- Whether you have other medical
conditions, such as
diabetes, or if you are being treated for
epilepsy.
A physical exam for Dupuytren's disease will usually
include:
- Moving your hand and wrist in various
positions.
- Moving your fingers to check for
flexibility.
- Feeling the palm of your hand for a knot (nodule) or
cord.
- Looking for any skin changes on your hand, such as dimpling
or thickening on the palm.
Treatment Overview
The goal of treatment for
Dupuytren's disease is to keep or restore hand
function. Dupuytren's disease often is a progressive disease, and recurrence is
common.
Initial treatment
Dupuytren's disease often develops slowly. If the tissue between your skin and
tendons (palmar fascia) does not thicken to the point that your fingers are
bent and cannot be straightened (contracture),
you may only need to have your palms checked regularly.
In the early stages of the disease, you may be
able to keep hand function by doing range-of-motion
exercises. In some cases, splints are used to try to slow the progress of the disease. But there is not much evidence that stretching or splinting helps.
Ongoing treatment
Treatment for
Dupuytren's disease depends on how bad the
disease is. You may notice the characteristic nodules in your palms years before
your condition interferes with daily activities, or you may never have a
reduction in your range of motion.
A long-acting
corticosteroid medicine is sometimes injected directly
into the affected area to help manage symptoms of the disease in its early
stages, before one or more fingers bends toward the palm (contracture).
Collagenase (such as Xiaflex) injected into the tight cord can help reduce the contracture and improve the range of motion.2
Treatment if the condition gets worse
In severe
Dupuytren's disease, the tissue between your skin and
tendons (palmar fascia) thickens to the point that your fingers are bent and
cannot be straightened (contracture). If you lose the ability
to wear gloves or hold objects, or if your hands become painful, a procedure may be
done to relieve the contracture. Surgery is most common, but some doctors are now doing needle aponeurotomy.
In needle aponeurotomy (also called percutaneous needle fasciotomy), a local anesthetic is injected into the palm. A needle is used to put small holes in the tight cords. The fingers are then extended to separate the cords. A splint is used to keep the finger straight as it heals.
Surgery can restore mobility to your hands, but Dupuytren's disease recurs often and
reoperation may be necessary to keep hand function. After surgery, a sustained
program—including using splints, stretching, and doing scar tissue massage and
hand exercises—may help you regain mobility and prevent
complications or recurrences of the disease.3
What to think about
Dupuytren's Disease: Should I Have Hand Surgery?
Home Treatment
Home treatment for
Dupuytren's disease focuses on keeping or restoring
hand mobility. You may be able to keep your hand function with regular
stretching of the involved fingers. Try twice-daily sessions of massaging the
hand and then gently stretching the fingers back to relieve tightness and help
keep your fingers flexible.
If surgery becomes necessary, home
rehabilitation after the procedure may help prevent
complications and recurrences of the disease. Try elevating the hand and arm to prevent swelling, wearing a splint as your doctor recommends to
prevent recurrence of
contracture, and exercising to keep or regain hand
movement.
After surgery, you can
help your scar heal successfully, as guided by your doctor. Scar
management may include therapeutic hand massages by a rehabilitation
specialist; massaging your hand at home, usually 2 to 3 times a day, following
your hand therapist's instructions; and using a splint that keeps pressure
against your palm and fingers.
Medications
Medicines that you take by mouth are typically not used as part
of treatment for
Dupuytren's disease. But there are injected medicines that may help.
Medication Choices
What to think about
Interferon is under study for relief of Dupuytren's disease.4
Surgery
Surgery is a treatment option for severe
cases of
Dupuytren's disease. The goal of surgery is to restore
the use of your fingers and hand. In most cases, surgery removes the diseased
soft-tissue bands that connect your finger joints to the palm, and may involve
a skin
graft. Total hand function may not be completely
restored by surgery. Even with successful surgery, thickened palm tissue may
develop again in the same place or in a new area of the hands. Reoperation is
often necessary to keep hand function.
You may improve the
outcome if you do postsurgical rehabilitation with finger exercises and
splints, as directed by your health professional.
- Dupuytren's Disease: Should I Have Hand Surgery?
Surgery Choices
Depending on your condition, your surgeon will choose one
of the following surgical procedures:
- Fasciectomy. Removal
of the affected tissue (fascia) is the most common procedure.
- Fasciotomy. The tight cords in the palm are divided through
small incisions. This procedure is used for people who cannot have more
extensive surgery or
general anesthesia.
- Amputation. Removal of one or more fingers is rarely needed
but may be done if earlier procedures have resulted in nerve or vessel damage
or the disease has recurred repeatedly.
In rare cases, the middle joint of the finger is fused
(permanently joined) to keep it from bending in.
What to think about
When you are deciding about
surgery, think about:
- The presence of any other health conditions
or diseases, such as
diabetes.
- Your willingness to go through
postsurgery rehabilitation, which is necessary in order to restore hand
function.
- How bad your loss of hand function is and how you are
affected in your daily activities.
- Your age. The risk of
complications and treatment failure are greater with
advanced age.
Needle
aponeurotomy is a form of fasciotomy that is done as an outpatient procedure
with
local anesthesia. It has been done for several years
in France, but it is just being introduced in the United States. This procedure
may be good for people who cannot have surgery, or as a way to delay surgery.
But it only partially corrects pulling or contracture between the fingers and
the palm. Also, there is chance of damaging nerves of the adjacent fingers. And
there is a high chance the contracture will come back.
Other Treatment
Rehabilitation (treatment by a
physical therapist or
occupational therapist) is a necessary step in
recovery after surgery on the hand. The goals of rehabilitation are to prevent
the buildup of fluid (edema), to manage scarring, and to get
back and keep your range of motion. It may include wrapping, splinting,
massage, stretching, and exercise. Your therapist may also recommend using
bigger grips or handles on equipment so you don't have to bend your fingers as
far.
Traction to lengthen and flatten the tissues of the hand is
being studied.1
Other Places To Get Help
Organizations
| American Academy of Orthopaedic Surgeons
(AAOS) |
| 6300 North River Road |
| Rosemont, IL 60018-4262 |
| Phone: |
1-800-346-AAOS (1-800-346-2267)
(847) 823-7186 |
| Fax: |
(847) 823-8125 |
| Email: |
orthoinfo@aaos.org |
| Web Address: |
www.orthoinfo.aaos.org |
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The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
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| American Society for Surgery of the Hand
(ASSH) |
| 6300 North River Road |
| Suite 600 |
| Rosemont, IL 60018-4256 |
| Phone: |
(847) 384-8300 |
| Fax: |
(847) 384-1435 |
| Email: |
info@assh.org |
| Web Address: |
www.assh.org |
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ASSH is a professional organization of hand surgeons
that provides education to the public about hand problems, such as Dupuytren's
disease, carpal tunnel syndrome, and tennis elbow. ASSH also provides education
about surgery, preventive tips to keep your hands safe, and an online tool to
find a hand surgeon.
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References
Citations
- Brown AN, Gilkeson GS (2005). Fibrosing diseases:
Diabetic stiff hand syndrome, Dupuytren's contracture, palmar and plantar
fasciitis, retroperitoneal fibrosis, and Peyronie's disease. In WJ Koopman, LW
Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 2093–2108. Philadelphia: Lippincott Williams and Wilkins.
- Hurst LC, et al. (2009). Injectable collagenase clostridium histolyticum for Dupuytren's contracture. New England Journal of Medicine, 361(10): 968–979.
- Hertling D, Kessler RM (2006). Dupuytren's contracture
section of Wrist and hand complex. In D Hertling, RM Kessler, Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods, 4th ed., pp. 421–422. Philadelphia: Lippincott
Williams and Wilkins.
- Townley WA, et al. (2006) Dupuytren's contracture
unfolded. BMJ, 332(7538): 397–400.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
Anne C. Poinier, MD - Internal Medicine |
| Specialist Medical Reviewer |
David Pichora, MD, FRCSC - Orthopedic Surgery |
| Last Revised |
August 18, 2011 |
Brown AN, Gilkeson GS (2005). Fibrosing diseases:
Diabetic stiff hand syndrome, Dupuytren's contracture, palmar and plantar
fasciitis, retroperitoneal fibrosis, and Peyronie's disease. In WJ Koopman, LW
Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 2093–2108. Philadelphia: Lippincott Williams and Wilkins.
Hurst LC, et al. (2009). Injectable collagenase clostridium histolyticum for Dupuytren's contracture. New England Journal of Medicine, 361(10): 968–979.
Hertling D, Kessler RM (2006). Dupuytren's contracture
section of Wrist and hand complex. In D Hertling, RM Kessler, Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods, 4th ed., pp. 421–422. Philadelphia: Lippincott
Williams and Wilkins.
Townley WA, et al. (2006) Dupuytren's contracture
unfolded. BMJ, 332(7538): 397–400.
