AT BEL AIR CENTER FOR PLASTIC AND HAND
Dupuytren’s disease, also called Dupuytren’s contracture, is a slow-developing hand deformity. This condition affects a tissue layer in the hand that lies under the skin. The tissue forms knots, which expand into thick cords that pull the fingers into a bent position. Once this happens, the fingers can no longer be straightened all the way, making daily tasks challenging.
Understanding Dupuytren’s Disease
The fascia is the tough connective tissue that lies over the muscles but below the skin. When Dupuytren’s disease is present, the fascia thickens. This begins in the palm, causing nodules and eventually cords. These thickened fibers pull the fingers into a permanent contracture. Sometimes, Dupuytren’s disease will also cause the tops of the knuckles to thicken as well. In some cases, the soles of the feet can also show symptoms. However, the ring and small finger are the digits that are most often affected.
Dupuytren’s contracture is seen most commonly in men who are over the age of 50, and who are of northern European descent. The development of Dupuytren’s disease is not related to any particular exposures or hand injuries. In fact, the cause of Dupuytren’s disease is not known, although medical science believes it to be some form of autoimmune disease where the body attacks its own tissues.
The symptoms of Dupuytren’s disease include the formation of bumps and pits under the skin, especially in the palms of the hands. Cords that look similar to tendons can also form. It’s common for both hands to be affected at the same time. Although there may be problems straightening the fingers, the disease itself is not typically painful. As the disease progress, the features may remain mild or become severe. The disease can take years to develop, or might progress over weeks or months. In some cases, it starts and stops at random. Symptoms tend to be more pronounced in younger patients who are diagnosed with Dupuytren’s disease.
Surgical Treatment for Dupuytren’s Disease
Surgical treatment for Dupuytren’s disease is still considered the gold standard. If symptoms are more pronounced, then the cords need to be broken apart to allow unrestricted finger movement again.
There are a few different surgical approaches for treating Dupuytren’s disease. A needle can be used to puncture the skin and break apart the constrictive cord. This procedure often needs to be repeated several times if symptoms return. However, it does not require an incision and can be performed on multiple fingers at once. Needling isn’t ideal for cords that develop too close to a tendon or nerve.
The affected tissue can be removed surgically. Usually this approach is only possible later in the progression of the disease, since the early symptoms are often too subtle to locate all of the affected tissue. Surgery offers a more complete release, although the recovery period is longer. Surgery may remove the worst portions of affected tissue, or all of tissue that may become affected as well.
Recovery and Results
Recovery following surgical Dupuytren’s disease treatment occurs gradually. At first, patients need to wear a splint and use hand therapy to help the hand heal with full range of motion. Although it can take a long time for the tissue to heal, many patients experience significant relief of symptoms after recovery. In cases of severe contracture, some of the symptoms may return. However, recurrence rates vary depending on the treatment approach. Total surgical removal offers the lowest chance for recurrence. Bel Air Center for Hand Surgery helps men and women from Harford County and surrounding areas in Maryland and Pennsylvania improve their quality of life by minimizing painful symptoms and restoring function.