Dupuytren’s (Guillaume, Paris 1777-1835) disease is a disorder caused by abnormal thickening of the tissue located just beneath the palm skin (fascia), which protects the tendon nerve and blood vessel structures. This thickening begins in the palm and can sometimes extend up to the fingers. Firm cords and lumps may develop; and as a result, the fingers bend towards the palm. Such a case is referred to as ‘Dupuytren’s contracture’. Although the skin may be affected, the deeper structures such as the tendons are not directly affected.
Despite being rare, keratosis may occur on the fingers throughout this disease period, and this may be accompanied by keratosis in the soles of the feet, called plantar fibromatosis, and keratosis in the penis.
What is the Cause of Dupuytren’s Disease?
The cause of Dupuytren’s disease is not completely known but certain biochemical changes occur in the affected fascia. The disease is more common in men over age forty and in northern European people. Whether hand injuries or certain professions increase the risk of this disease has not exactly been proven. Although it is seen more commonly in little and middle fingers, it can also affect all fingers.
What are the Symptoms and Findings of Dupuytren’s Disease?
The main symptoms of Dupuytren’s disease are lumps and pits in the palm. The lumps are generally very firm and strongly adherent to the skin. Thick cords may develop, which may extend from the palm towards one or more fingers. Usually the ring finger and little finger are affected. These cords may sometimes be mistaken for tendons; however, such a thickening occurs between the skin and tendons. These cords may cause bending or contractures in the fingers. In many cases, both hands are affected but there may be a difference between the two hands, in terms of the degrees of their diseases.
It may initially cause nodular discomfort but it goes away on its own. In fact, Dupuytren’s disease is usually not painful. The disease is first noticed with the patient’s inability to place his/her hand on an even surface, such as a tabletop. As the fingers bend towards the palm, certain activities such as washing hands, wearing gloves, shaking hands, and putting hands into pockets begin to be difficult.
Progression of the disease is unpredictable. In some individuals, nodules and cords may develop only in the palms. But in some other patients, the fingers bend towards the palm. At earlier ages, the disease usually progresses faster.
What are the Treatment Options for Dupuytren’s disease?
In mild cases, especially when hand functions are not affected, only observation is adequate. For advanced cases, several treatment procedures intended for straightening the finger(s) are available.
Treatment options are as follows: Collagenase injection, needle aponeurotomy, and open surgery.
In collagenase injection, a small amount of medicine is injected into the tissue to weaken it. After making the tissue weak, the finger can easily be controlled and sometimes can be straightened.
In needle aponeurotomy, Dupuytren’s contracture can be cut by applying serial percutaneous injections into the affected tissue. Collagenase injection and needle aponeurotomy are procedures that can be carried out under polyclinic conditions.
In surgical approaches, the main objective is to readjust the impaired functional capacity and correct the deformity of the affected hand, and to prevent recurrence.
The surgery consists of the removal of wrinkled tissues; and in some cases, involves the transplantation of a skin part (graft) taken from other parts of the body, or other surgical interventions. The hand will be bandaged in such a way as to ensure that it remains open for a period of several days or weeks, and then physiotherapy for fingers and hand exercises should begin.
Postoperative complications can be listed as problems with wound healing, infection, hematoma, nerve injury (neuroma-hypoesthesia), artery injury (cold intolerance, circulatory disorder), and joint stiffness. Besides these, reflex sympathetic dystrophy may develop, as well.