Dupuytrens disease is typically inherited and presents as a thickening of the fascial layer of the palm and fingers between the skin and the deeper nerves, arteries and tendons. It is most commonly seen in patients with family from Northern Europe; the disease is thought to have been spread by the Vikings 1000 years ago.
It often begins in palm with nodules of thickened tissue; while initially painful, these nodules typically become pain-free over time. Painless longitudinal “cords” or bands form beneath the skin in some patients causing the fingers to bend towards the palm. Most commonly, the joint between the fingers and the palm (MCP joint) is affected, but any of the joints can be involved. The fingers keep their ability to bend but lose the ability to completely straighten, interfering with activities.
The decision on whether to proceed with any treatment for Dupuytrens disease is purely the patient’s choice. Steroid injections can be given in the palm if the nodules are painful. If the cords interfere with function, there are 3 treatments. It is important to realize that none of these options cure Dupuytrens disease and the disease can come back after any of these treatments.
1. The classic, time-tested procedure is a formal operation with excision of all the diseased tissue. This requires large skin incisions and hand therapy after surgery. It is typically several months before full resumption of activities. This option many provide the longest disease free period of time.
2. Needle Aponeurotomy. This office-based procedure is done with several small injections of numbing medicine. A needle is then used to divide the cord and improve motion. It has been proven safe and has a very quick recovery with return to all activities within a week.
3. Collagenase injection is also an office-based procedure that involves an injection one day and a manipulation of the finger to disrupt the cord the next day. The medicine injection on day 1 dissolves the cord allowing improved straightening of the finger(s).