Dupuytren’s Disease

Dupuytren's Contracture

Why does it occur?

Dupuytren's can be a hereditary condition or it may occur in combination with other contributory factors including diabetes, epilepsy and excessive alcohol intake and heavy smoking. The exact cause is unknown. The palmar fascia in the hand becomes thickened nodular and contractile.

What are the symptoms?

The ring and small finger are most commonly affected. Palmar fascia affected by this condition becomes thickened and contracts. Over time the fingers are pulled towards the palm and cannot be forced straight.  Dupuytren's tissue is not usually painful but its effects can be inconvenient such as difficulty wearing gloves, a finger not releasing a cup properly and difficulty getting the hand into a pocket.

Investigations

None are required as the diagnosis is made from the clinical presentation.

The table top test is a useful guide to tell when the contracture is getting to the stage that surgery would be considered. This simple test is performed by placing the hand palm down on a flat surface. If it is not possible to get the hand completely flat  the test is positive.

Treatment options

  • Non-operative treatment

Surgical intervention is required when the contracture interferes with daily activities.

  • Operative treatment

Fasciectomy - Anaesthesia will be governed by the extent of the fasciectomy required and will be discussed in advance of surgery. Local anaesthetic can be used for surgery of short duration.

A tourniquet (tight cuff) is placed at the top of the arm to reduce blood flow during surgery.

An incision is made along the path of the contracture (this looks like a zig-zag, which allows for efficient healing and movement after the surgery). The tissue responsible for the contracture is removed and the wound is closed using stitches. Dressings and a plaster splint are applied to maintain the affected fingers in the corrected position.

If the contracture has been severe or in recurrent contracture a skin graft may be required so that the finger is able to be straightened and the skin sutured without tension.The graft would be taken from the wrist or the elbow. The requirement for this procedure would be discussed prior to surgery.

Complications

Nerve and blood vessel injury - every effort is made to minimise this risk but the tiny nerves and blood vessels are often in close proximity to the tissue being removed. If damage were to occur part of the affected finger may become temporarily or permanently numb to touch.

Chronic Regional Pain Syndrome Type 1 - (incidence of 1 %) this condition can occur after injury or surgery and would mean more pain and stiffness which would require analgesia and hand therapy.

Rehabilitation after surgery

The plaster splint will be removed so that dressings can be changed. The Hand Therapists will make a resting splint, to be worn at night for up to 6 months. Stitches are removed after 7-10 days.

Frequently asked questions

Return to driving - many people begin to drive once the stitches have been removed but you must ensure that you can safely control the vehicle.

Recurrence - surgery does not provide a permanent solution to Dupuytren's disease. After surgery more tissue may develop  which may need to be removed if it  causes a further contracture that interferes with daily activities.