Introduction
Dupuytren’s disease is a condition that leads to the abnormal thickening of the tissue beneath the skin of the palm. As this tissue thickens, it may form firm lumps or tight cords, causing the fingers to bend toward the palm. Over time, the disease can progress and result in contractures, leading to significant loss of hand function. Though the progression of Dupuytren’s disease is generally slow, it can vary greatly from person to person, making it difficult to predict how the condition will advance.
Anatomy
The palm of the hand is composed of ligaments and tendons. Ligaments are tough, fibrous bands that connect bones, while tendons are structures that link muscles to bones, allowing for movement. The tendons in the palm specifically help bend the fingers inward. These ligaments and tendons are covered by a thin layer of connective tissue known as the palmar fascia, which sits directly under the skin and plays a key role in Dupuytren’s disease.
Causes
The exact cause of Dupuytren’s disease remains unknown. However, it is believed to be related to abnormal biochemical activity within the palmar fascia. The disease is more prevalent among individuals of Northern European descent and affects men more frequently than women. Although uncommon in young people, when it does occur at a younger age, it often progresses rapidly and severely. Dupuytren’s disease is also linked to certain lifestyle factors like smoking and alcohol use, as well as medical conditions such as diabetes, thyroid disorders, epilepsy, tuberculosis, and liver disease.
Symptoms
Dupuytren’s disease often develops slowly and may affect both hands, although one hand is typically more impacted than the other. Early symptoms include the appearance of a small, tender lump in the palm, which usually loses its tenderness over time. The disease is typically painless, but as it progresses, thickened cords may form beneath the skin, causing the fingers—particularly the ring and little fingers—to bend toward the palm. Over time, individuals may find it difficult to fully straighten their fingers. The progression of symptoms can vary, with some experiencing mild thickening and others facing severe contractures that limit hand function.
Diagnosis
Doctors typically diagnose Dupuytren’s disease through a physical examination. Patients should inform their doctor of any symptoms that limit hand function. During the exam, the physician will feel for thickened tissue or nodules in the palm and assess finger positioning and joint movement. One common test used in diagnosis is the Table Top Test, where patients attempt to place their hand flat on a surface. Difficulty in fully flattening the hand may indicate the presence of finger contractures associated with the disease.
Treatment
Currently, there is no cure for Dupuytren’s disease or a way to halt its progression. However, doctors can monitor the condition and recommend interventions if symptoms worsen. Injections may be used to alleviate early-stage pain caused by lumps. In more advanced cases, where finger flexion interferes with hand function, surgical intervention is often required. An injectable enzyme called Xiaflex, approved by the FDA in 2010, has shown success in dissolving the diseased tissue and improving finger mobility in patients with Dupuytren’s contractures.
Surgery
The primary goal of surgery for Dupuytren’s disease is to restore finger mobility and improve hand function. Several surgical options are available, depending on the severity of the condition. A fasciotomy, which involves cutting the thickened bands of tissue, may be sufficient in some cases. In more severe cases, a fasciectomy, which involves removing the affected palmar fascia, may be necessary. Some patients may also require a skin graft to cover areas where large portions of tissue are removed.
Recovery
After surgery, patients typically engage in rehabilitation with a hand therapist. The therapist will guide them through exercises designed to stretch and strengthen the hand. Additional therapy treatments may be provided to manage swelling and reduce pain. A custom splint may be used to maintain proper hand positioning during recovery. While surgery can restore hand function, Dupuytren’s disease often recurs over time, making long-term monitoring necessary.
