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Dupuytren’s Contracture

In 1831, a famous French surgeon, Baron Guillaume Dupuytren, described a contracture of the tissue beneath the skin of the palm which now bears his name. It can be severe enough to cause deformity in the hand and interfere with normal use. It is a gradually advancing disease, and can cause progressively more curling up of the fingers.

No one understands the cause of this disease. People often wonder if injury can cause it. Scientific studies have shown that it probably can not.

Dupuytren’s disease tends to run in families. It does not follow, however, that if a patient’s father or mother had it he is necessarily going to get it. It is particularly common among Caucasians, especially those of Northern European descent. It is rare in other races, though it can occur.

The disease usually begins with small lumps in the palm of the hand, at the base of the ring or small fingers. Discomfort may be associated with these lumps, particularly if they are in locations which are subject to repeated injury in a patient’s job, but usually, the disease is painless.

diagram Lumps can progress to cords, which extend from the palm into the fingers. Cords cause bending of the joints of the hand which can progress to severe flexion deformities. This can occur slowly or rapidly, and it is difficult to predict the rate at which it will occur. Sometimes progression may stop. It can start again unexpectedly. The disease may progress to the point that everyday and work activities become difficult or impossible.

The skin can be intimately involved in the process, and sometimes removal of some of the skin is necessary for surgical treatment. The tendons which control the fingers are not involved, though the nerves and blood vessels to the fingers can be intertwined with the diseased fascia.

Treatment

At present the only treatment for Dupuytren’s disease is surgical removal of the diseased tissue. Research continues into the biochemical causes of the disease. Eventually a medical prevention or treatment may be available, but this is not on the immediate horizon.

Surgery may be recommended when the fingers begin to bend or if the hand can not be placed flat on a table. Rapid progression which interferes with normal hand function may warrant early surgery.

Despite surgical removal of the diseased fascia, the disease may occasionally return. Surgery may not completely cure the disease. The goal of surgery is to retain normal hand function.

Surgical treatment involves making usually zig-zag shaped incisions in the palm to remove the diseased fascia. Most often, block anesthesia is used, in which the arm is completely numbed but the patient is not put completely to sleep. This is the safest for most patients, and comfortable both during and after surgery. Often patients will be able to go home the day of surgery, though it may be prudent, in some cases, to spend a night in the hospital. Sometimes part or all of the wound may be left open intentionally by the surgeon, depending on the condition of the patient’s remaining skin. Often, small plastic tubes or drains will be inserted, which will be removed one to two days after surgery. The post-operative dressing applied by your surgeon is designed to immobilize the hand and provide compression to the wounds.

diagram Post-operative therapy is essential to obtaining a good result. It will begin usually within a few days of surgery, and may last for up to six months after surgery. A number of different plastic splints may have to be worn during this period to attain full motion and maintain the contracture-free state of the fingers. These may have to be worn for up to one year. Patients can generally not return to repeated use of the hand for three to six months. Lighter occupations and activities can be resumed earlier.

Several complications can occur from the treatment of this disease. The incisions will remain tender for quite some time. Bleeding or infection can occur and slow recovery. Joint stiffness may occur. Nerves or blood vessels to the fingers may occasionally be damaged. Full mobility may never be regained. Recurrence is always possible.

While research into the causes of Dupuytren’s disease may someday provide an alternate cure, for the present, surgery remains the only form of treatment.