What is Dupuytren’s Disease?
Dupuytren’s disease, also called Dupuytren’s contracture of “Viking’s disease,” is a skin deformity that develops slowly over time. The disease causes the tissue under the palms of the hands to thicken abnormally in the area between the skin and the tendons, sometimes resulting in limited hand dexterity. When the disease becomes serious enough, fingers may become stuck in abnormal, bent positions that cannot be straightened.
Dupuytren’s disease typically affects those aged 55 years or older and most commonly affects the pinky and ring finger. While there is no set cure for this disease, treatment options are available to alleviate pain, treat symptoms, and slow the progression of the disease.
Doctors have yet to determine the exact cause of Dupuytren’s disease. Some theories suggest that it may be related to an autoimmune reaction, which causes the body to attack its own tissues. Heredity may also be a factor, as the disease seems to affect family members and people of northern European descent. Alcoholism, smoking, and diabetes may expedite the thickening of the fascia.
Dupuytren’s disease is rarely painfully and develops slowly over time. The pinky and ring fingers are the most likely to suffer from the disease; only rarely are the thumb, pointer, and middle fingers affected. The usual progression of symptoms is as follows:
- A small lump in the palm: Small knots of toughened tissue under the palm of the hand is a common early sign of the disease. These lumps may be sensitive when pressure is applied, but they usually are not painful.
- Changes in skin appearance: The skin on the palms may become puckered or dimpled.
- Spreading to the fingers: Over time, a thick rope-like strand of toughened fascia may attach to the finger, pulling it towards the palm and creating an abnormal, strained bend or curve in the finger.
- Loss of dexterity and flexibility: Eventually, you may not be able to straighten or flatten your fingers or hand due to the toughened ligaments.
Your doctor can conduct a simple physical exam to rule out any other skin or tendon conditions and confirm the presence of Dupuytren’s disease. He or she will check for puckered skin on the palms of your hands, lumps or knots under the skin, and stiff or inflexible fingers. Imaging tests are rarely necessary but may be used to rule out other possible conditions
Since Dupuytren’s disease is not yet curable, the primary goal with treatment is to alleviate symptoms and maintain as much hand dexterity as possible. Some people forgo treatment altogether, as the disease often does not cause pain and, if it does not drastically affect the fingers, does not interfere with basic mobility and flexibility. Treatment options are available that break or loosen the tightening ligaments, releasing the tension on the palms and fingers. Some methods include:
- Needling: In this procedure, your doctor will insert a needle through the skin to puncture and sever a toughened tissue cord causing a finger to contract. No incisions are needed, and a small amount of physical therapy afterwards will help recovery.
- Enzyme injections: Your doctor can inject the affected area with certain enzymes in order to soften the toughened tissue under the palms and subsequently relieve the amount of tension in the hand.
- Surgery: If your case of Dupuytren’s disease has become painful or has started interfering with your daily life, your doctor may recommend the complete surgical removal of the toughened tissue. Serious cases may require skin grafts in order to fully remove all affected or potentially affected tissue, and recovery time can range from several weeks to several months. Physical therapy can help patients regain flexibility and mobility in the affected hand post-surgery.