What is Dupuytren’s disease?
Dupuytren’s disease (pronounced du-pwe-TRANZ) is a common disorder involving the hands.
The tissues within your palm and fingers shorten (contract) over many years into thick bands that run along the fingers. The shortened fibers slowly pull at the finger joints, causing them to bend. It becomes hard or impossible to fully straighten.
Dupuytren’s disease (also called Dupuytren’s contracture) can affect one or more fingers. It’s usually the ring finger and pinky, but it can affect other fingers.
It may cause skin dimpling (pitting) and cord-like bands within the palm. It can also cause thickened skin over the second knuckle.
Many people don’t need treatment, depending on the severity of the symptoms. The goal of treatment is to restore function and range of motion, though it doesn’t always completely fix the issues.
Most common symptoms
I listen for a patient to say something like: “I have trouble with dexterity, trouble taking things in and out of a pocket, trouble with small things.” —Dr. Bradley Graw
One or more fingers is pulled in a bent position towards your palm. It is usually painless. You’ll also have difficulty laying your hand flat on the table.
Most patients with Dupuytren’s disease are not bothered by the symptoms until the finger bends more than 20 degrees. At that point, it can affect your ability to use your fingers. But that can take years or even decades to develop.
- Involuntary bending of the finger joints at rest
- Not able to fully straighten the finger
- Skin dimpling (pitting)
- Visible cord-like bands and nodules on the palm
Other symptoms you may have
- Thickened skin over the second knuckle (Garrod’s pad).
What causes Dupuytren’s disease?
Dupuytren’s disease is a genetic disorder. Most people who get it have a family history of the disease. It causes the fibrous tissue in the palm to become thicker and shorter over the course of a lifetime. The shortened fibers slowly pull at the finger joints. It causes them to bend towards the palm and makes it hard or impossible to fully straighten.
Many people with Dupuytren’s disease are of northern European descent. Usually, people are above the age of 50, typically in their 60s, or 70s, when they start showing symptoms. It is more common in men. Diabetes and alcoholism increase your risk for the disease.
Dupuytren's disease treatment
Ask your doctor: At which point would you recommend injection or surgical treatment for me? —Dr. Graw
It’s important to see an orthopedist or plastic surgeon who specializes in hands as soon as you notice symptoms. Dupuytren’s is easier to treat in its early stages before it gets too severe. The doctor will be able to diagnose you just from looking at your hand.
Treatment is focused on restoring your finger’s ability to straighten. Usually, that’s done in an in-office procedure. This includes injecting enzymes to soften the tight fibrous bands, or using a needle to break them apart. You may need to have the procedure more than once to break down the bands.
For more severe disease, surgery may be needed to cut out the tight bands entirely. Surgery can come with risk of infection and other complications.
Most mild-to-moderate cases of the disease can be well treated with these procedures. If it’s severe, though, it may be less successful. Typically hand therapy is required for up to 12 weeks after treatment to help you regain your finger function and range of motion.
After an in-office procedure or surgery, you may need to wear a temporary splint to keep the finger straight. Or get cortisone injections to prevent the bands from reforming. Sometimes, skin tears can occur during the procedure. But these tend to heal extremely well by themselves.
In most cases, treatment results in immediate improvement. But sometimes, the tight bands can develop again over the course of years.