Dupuytren’s disease is an abnormal thickening of the tissue just beneath the skin. This thickening occurs in the palm and can extend into the fingers. Firm pits, nodules, and cords may develop that can cause the fingers to bend into the palm, which is a condition described as Dupuytren’s contracture.
Dupuytren’s Contracture is a disorder of the palm and the fingers, which results from a genetic change in the tissue called the palmar aponeurosis underneath the skin which is usually designed to prevent the skin from sliding around when we are gripping objects. It usually occurs in late middle age or older and causing nodules, pits and cords in the palm which connect to the fingers and often cause a contracture of the fingers either at the main knuckle or the knuckles within the fingers. This is a rigid sheet of tissue which is inflexible and resistant to stretching.
This can progress relatively quickly or extremely slowly and generally treatment is advised when the patient has noticed significant difficulties with flattening the hand on a table. Difficulties in dexterity and using the hand as well as pain and discomfort gripping objects can be experienced by patients, and it is wise to seek early advise in regard to treatment options.
Observation and Monitoring
In the first instance, we observe and monitor the pace at which the disease is progressing to determine the plan for treatment. If the disease is aggressive vs if it's quite gentle in it's progression will determine the course of treatment we take.
Radiotherapy in the early stages of the disease. Radiotherapy has been shown to improve nodules and minor contractures but is generally only recommended for people who have significant nodules and pain in the palm on gripping but without significant deformity of the fingers. This can be discussed at the time of your appointment if necessary.
Hand therapy is not really something that is used for treatment of Dupuytren’s Disease in the pre-surgical phase as stretching of tissue is not really possible and ineffective.
Surgery can be very effective in relieving the contracture, either removing disease from the palm and straightening the fingers and this can be relatively straight forward or can be very complex depending on the degree of severity of the deformity and whether the joints of the fingers are involved as well.
These were previously available in Australia, but presently are unavailable. They have been successfully used for treating simple cords to 1 or 2 fingers and require 2 visits to the office under local anaesthetic to treat the cord.
It may well be that this will be available again in Australia fairly soon. You can obviously discuss this with Dr Melsom at your appointment if this becomes available.
Needle aponeurotomy is similar to the injection described above except is done in the office under local anaesthetic and can be used with very select cords to the finger where a needle is used to divide the cord under local anaesthetic. This can be very useful for patients who have got a very simple cord and deformity and can be a very effective alternative to surgery in certain circumstances.
Post-operative course usually involves hand therapy and splinting to maintain the position of the finger in extension and early active movement. Most surgery is uncomplicated and results in excellent range of movement and function after the wound is healed at 2 weeks.