Dupuytren's Disease
Dupuytren’s Disease (also called Dupuytren’s Contracture) is a condition that affects the connective tissue beneath the skin of the palm and fingers.
Dupuytren’s Disease
What is Dupuytren’s Disease?
Dupuytren’s Disease (also called Dupuytren’s Contracture) is a condition that affects the connective tissue beneath the skin of the palm and fingers. Over time, this tissue thickens and forms cords, which can cause the fingers to bend towards the palm and limit hand function. The condition is usually slow-growing and often painless, but it can significantly impact daily activities when contractures become severe.Anatomy & Causes
Dupuytren’s Disease affects the palmar fascia, a sheet of tissue that stabilises the skin of the palm. As this tissue thickens and tightens, it pulls one or more fingers into a bent position.The exact cause is unknown, but risk factors include:
- Family history (genetic predisposition)
- Increasing age (most common in people over 50)
- More common in men than women
- Association with diabetes, smoking, or alcohol use
Common Symptoms
- Thickened nodules or lumps in the palm
- Formation of cords beneath the skin
- Fingers (most often the ring and little fingers) slowly bending toward the palm
- Difficulty placing the hand flat on a table
- Impaired ability to grasp large objects or perform fine motor tasks
Diagnosis
Diagnosis is usually straightforward and based on physical examination. Your surgeon may perform the “tabletop test”, where the palm is placed flat on a surface—an inability to do this suggests significant contracture. Imaging tests are rarely needed.Treatment Options
Non-Surgical Management
In the early stages, if there is no functional impairment, active treatment may not be necessary. Monitoring the progression of the disease is often recommended.Minimally Invasive Treatments
- Needle Aponeurotomy (Needle Fasciotomy): A needle is used to divide the cords in the palm, allowing the fingers to straighten.
- Collagenase Injections: An enzyme is injected to soften and weaken the cord, followed by manipulation of the finger to restore movement.
Surgical Treatment
- Fasciectomy: Surgical removal of the affected tissue to straighten the finger(s).
- Dermofasciectomy: Removal of diseased tissue and overlying skin, sometimes with a skin graft, to reduce recurrence risk.
Post-Surgery Care
- Splinting and physiotherapy are often required to optimise movement and function.
- Stitches are removed within 10–14 days.
- Recovery may take several weeks, depending on the extent of surgery.
Risks & Outcomes
Treatment can greatly improve hand function, but Dupuytren’s Disease can recur over time. Risks include:- Stiffness or reduced finger mobility
- Nerve or blood vessel injury (rare)
- Scar tenderness
- Recurrence of contractures