Dupuytren's Disease

What is Dupuytren’s Disease?
Dupuytren’s disease is a slowly progressing contracture of the digits caused by a genetic condition. It occurs spontaneously and is not a result of overuse or trauma. Dupuytren’s contractures tend to be found in people of Northern European ancestry, may be associated with alcohol consumption or diabetes, and increases in frequency with age.

How is Dupuytren’s Disease diagnosed?
Dupuytren’s disease is diagnosed by physical examination. The hand may have nodules or bands that are pulling the fingers toward the palm. Occasionally, the nodules can be painful.

How is Dupuytren’s Disease treated?
Nonsurgical treatment: Most patient with Dupuytren’s disease are treated with observation. The contractures progress slowly and are not functionally limiting until the joints are significantly flexed. If the nodules are painful, a steroid injection can be considered. Unfortunately, hand therapy is not effective for preventing progression of the contractures.

Surgical treatment: Once the fingers have progressed to the point where the inability to straighten is affecting hand function, surgical release of the contracture is usually recommended. This can be done percutaneously with a needle or through multiple incisions with a procedure called partial fasciectomy.

Partial Fasciectomy: There have been many variations of surgical treatment for Dupuytren’s disease but almost all involve opening the skin of the hand and removing the diseased and contracted tissue from the hand. This can be a relatively large operation and the wounds can take some time to heal but the result is restoration of finger extension and greatly improved hand function. The nerves to the fingers run right through the diseased tissue and great care is required to protect them throughout the surgery. A splint is worn for a short period of time after the surgery and hand therapy is started almost immediately.

Percutaneous Dupuytren’s Release: Also known as percutaneous needle aponeurotomy (NA), this procedure has been used for some time in Europe. Instead of opening the skin of the hand through relatively large incisions, a needle is used to sever the tethering cord in the hand and allow the finger to straighten. The procedure has the advantage of a quick recovery and the possibility of being performed in the office. The disadvantages are a result of the tissue not being directly visualized and removed; therefore, the risk of recurrence or nerve injury is slightly higher.

Which treatment should I select?
Each patient requires individual assessment of their symptoms prior to deciding the optimal treatment. Dr. Rose has experience with all the above techniques and can provide an assessment and explanation of the options available to you for Dupuytren’s Disease. Please contact us to schedule an appointment.

Dupuytren’s Disease references:
Dupuytren Society Needle Aponeurotomy Webpage - Site of an international research group dedicated to Dupuytren’s disease
E-hand Needle Aponeurotomy - A nice illustration of the procedure.
American Academy of Orthopaedic Surgeons Patient Information
American Society for Surgery of the Hand Patient Information