Dupuytren's Disease

Topic Overview

What is Dupuytren's disease?

In Dupuytren's (say "duh-pwee-TRAHNZ") disease, tissue under the skin in the palm of your hand, called the palmar fascia, gets thicker and shorter. This can cause your fingers to bend in toward your palm. It most often affects the ring and small fingers, usually of both hands.

The disease may only involve the palm and never affect your fingers. If it gets worse, it may be hard to use your hands.

Dupuytren's disease is also called Viking's disease.

What causes Dupuytren's disease?

What causes it isn't known, but your risk of having Dupuytren's is increased if you:

• Have relatives who have the disease.
• Are of northern European heritage.
• Are male.
• Are older than 50.
• Have diabetes or alcoholism.
• Smoke.

What are the symptoms?

The disease has three general phases:

• In the early phase, you may see or feel a small lump in the palm of your hand, usually near where your ring finger and small finger meet.
• In the active phase, you may have dimpling on the skin of your palm. Long, ropey cords or bands form in the fascia. You may be able to see or feel them.
• In the advanced phase, a fibrous cord may form in the fascia that pulls your fingers toward your palm. This is called Dupuytren's contracture. Over time, you won't be able to straighten your fingers or flatten your hand on a table. It may be hard or impossible to do things like put on gloves, wash your hands, or pick up things.

In most cases, Dupuytren's doesn't cause pain. You may not even notice it until you develop a contracture.

The disease usually gets worse slowly. In many people, it never causes major problems.

How is Dupuytren's disease diagnosed?

A physical exam and medical history will usually give enough information for a doctor to decide if you have Dupuytren's disease. Your doctor will:

• Look for skin changes on your palm and feel for any knots or a cord.
• Watch you move your hand, wrist, and fingers.
• Ask questions about your family, your symptoms, any other medical conditions, and your history of tobacco and alcohol use.

How is it treated?

The goal of treatment is to keep your hand working as well as it can. You may not need treatment unless you have a contracture. Treatment options include:

• Collagenase injection. A medicine called collagenase (such as Xiaflex) may be injected into the tight cord to try to dissolve some of the tissue. This may help reduce the contracture and improve your range of motion.
• Needle aponeurotomy (say "ap-uh-noo-RAH-tuh-mee"). A needle is used to make small holes in the tight cords in the palm. Then the fingers are extended to separate the cords.
• Surgery to remove or separate the affected tissue in the palm.

The surgery most often done for a contracture is called a fasciectomy (say "fash-ee-ECK-tuh-mee"). The surgeon removes the thick tissue under the skin of the palm. A skin graft may be done to cover open areas in the palm. After surgery, you will need to follow a program of hand exercises and massage to help you move your fingers again.

Your hand may work better after surgery, but you may not get back the full use of your hand. And even when surgery is successful, Dupuytren's comes back about half the time. So you might need another surgery later.

What can you do to keep Dupuytren's from getting worse?

If your symptoms are mild, you can try gentle stretching exercises and massage. There isn't much evidence that they reduce symptoms or slow the disease, but they are easy to do. And they may help keep your hand flexible.

You can also try to avoid curling your hand tightly. For example, you can use utensils and tools that have larger hand grips.