Dupuytren's Disease

What is it?

Dupuytren’s disease is the thickening of the fascia beneath the skin in the palm of the hand (the palmar fascia) . The fascia is a thick fibrous tissue layer which acts to protect the vital structures in your hand. It is also firmly bound to the overlying skin – preventing the skin sliding when gripping objects. Thickening of the fascia causes a contracture of fingers known as Dupuytren’s contracture. However, the finger tendons lie deep to the fascia and are not involved in the disease.

Who gets it and what causes it?

There is a genetic component to the condition, as it seems to run in families and affect people of Northern European ancestry. Typically men over 40 years of age are affected.

What are the signs and symptoms?

At first, pits, nodules and thickening are noted within the palm. At a later stage thick cords develop extending from the palm into the fingers, which cause progressive contractures of the fingers. Typically the ring and little fingers are affected but the thumb and other areas can be involved. Difficulties occur in carrying out daily activities such as shaking hands, wearing gloves and washing your face.

Other regions of the body including the knuckles, the soles of the feet and the penis may be affected by a similar disease process.

What tests will I need?

The diagnosis can usually be made with a consultation, involving a medical history and clinical examination. No specialised tests are needed.

What is the treatment?

In mild cases, it may be that no treatment is necessary. However, should the condition be more severe there are a number of treatment options:

  • Multiple needle aponeurotomies (needle fasciotomy): This involves cutting the thickened cords using a needle and is relatively non-invasive;
  • Excisional surgery is more invasive but in some cases may be indicated, though Mr Miller prefers even then to keep this surgery as minimal as possible, through small incisions, to aid post-operative recovery. Dupuytren’s disease cannot be cured with surgery, therefore the aim of surgery is to improve function by releasing the contracture.

What does the surgical treatment involve?

Surgery aims to release or remove the thickened fascia allowing the finger(s) or thumb to be straightened, improving function and reducing symptoms

Mr Miller performs Dupuytren’s surgery at Claremont Private Hospital. The surgery usually lasts anything between 20 minutes to up to 1 hour depending on the extent of the disease. It is usually a day case procedure requiring only local anaesthesia. 

What happens after the surgery?

Taking simple painkillers regularly for the first few days after the operation will help to relieve any post-operative pain. Stitches, if required, are of the resorbable (dissolving) kind so will not need removal. A wound check will be organised either at your GP surgery or at the Claremont Hospital 5-7 days after your operation and a follow-up appointment to see Mr Miller 1-2 weeks after that.

When I can return to normal activity (work, driving, sports)?

If you perform heavy manual work it is advised to stay off work for 3-6 weeks; otherwise a period of 1-2 weeks off work is recommended to allow you to recover.

You are advised not to drive for at least 1 week after surgery.

What are the complications of surgery?

Complications of Dupuytren’s surgery can include infection and rarely nerve injury (<1%). Sometimes complete release of the contracture may not be possible and a residual contracture may still be apparent post-operatively. This is particularly noted in patients with contractures affecting the middle or end joints of the finger. The contracture can recur, but should this occur it can be treated with a further procedure. A small percentage of patients (1% or less) will develop a severe reaction after hand surgery (called CRPS), with long-standing pain and loss of use in the hand which is something that is difficult to treat. If you are concerned about any of these risks, or have any further queries, please speak to Mr Miller.