DUPUYTREN'S DISEASE

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Dupuytren's disease is a benign condition which affects the hand. The disease process involves the connective tissue found in the palm of hands. This tissue is replaced by thickened cords. As the disease progresses, it causes distortion of the surrounding structures which pull the fingers into the palm. It is referred to as contracture when there is an inability to extend the fingers.  

What are the risk factors of Dupuytren's disease? 
The risk factors which are associated with an increased likelihood of Dupuytren's disease include: 

1.  Alcohol intake
2. Smoking
3. Use of vibrating tools
4. Age more than 40 years
5. It affects men more than women
6. Diabetes

In most cases, there are no identifiable risk factors.

What are the symptoms of Dupuytren's disease? 
The symptoms include: 

1. Localized thickening of the skin of the palm
2. Puckering or dimpling of skin
3. Inability to fully extend the fingers
4. Fingers get drawn into the palm in late stages

Dupuytren's disease can affect one or both hands. It most commonly affects the ring and little fingers. Rest of the digits are less commonly involved. Usually, pinch and fine activities are preserved. Patient has an inability to fully extend the fingers resulting in difficulty in grasping large objects. The initial stages may be associated with pain. But Dupuytren's disease is largely a painless condition. 

What is the natural history of disease? 
The progress of the disease is variable. In many cases, the disease remains without progression for a long time. 

How is Dupuytren's disease diagnosed? 
The diagnosis is based on clinical findings. Hence, additional investigations are usually not necessary for the diagnosis. 

What are the treatment options for Dupuytren's disease? 
The decision to treat is based on the clinical findings. In early cases without significant deformity, it may be enough to keep under observation. Treatment options include: 

1. Local injection of steroid is sometimes done in early cases without contractures. This may have to be repeated at intervals for the desired results. 
2. Needling is a less invasive technique in which a needle is used to break the fibrous cords. However, it has the risk of damage to tendons and nerves. 
3. Surgical treatment consists of open removal of the fibrous cords. Surgery is usually carried out under local anesthesia with or without sedation. Sutures are removed between the first and second weeks after the procedure. Hand therapy is important following surgery. Surgery is  associated with longer lasting results with good functional restoration.

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Dupuytren's disease of hand with cords marked in blue

Local injection of steroid into the nodules

Surgical removal of the diseased cords