Dupuytren’s Disease

This information provides an overview of Dupuytren’s disease (also known as Dupuytren’s contracture) and the available treatment options. It is intended as a general guide and should not replace advice from your surgeon.

What is Dupuytren’s Disease?

Dupuytren’s disease is a condition affecting the hands and fingers. Pronounced “doo-pwee-tranz,” it was first described by French surgeon Baron Guillaume Dupuytren in 1834.

This condition occurs when thickened tissue develops in the palm’s connective tissue, often at the base of the ring and little fingers. Over time, this tissue may form a fibrous cord that pulls one or more fingers toward the palm, making it difficult to straighten the affected fingers fully. This is referred to as a Dupuytren’s contracture. While it most commonly affects the ring and little fingers, other fingers and even the thumb can also be involved. Both hands may be affected.

In most cases, Dupuytren’s disease is painless, though some individuals may experience mild pain in the early stages. It is not a life- or limb-threatening condition, but it can interfere with hand functions such as putting your hand into a pocket or wearing gloves.

How Common is Dupuytren’s Disease?

Dupuytren’s disease is relatively common, particularly among white Europeans. It is more prevalent in men than women and typically occurs later in life. The condition affects up to 20% of men over 60 and 20% of women over 80.

The condition is often hereditary, with a strong genetic predisposition. Other risk factors include:

Heavy drinking
Smoking
Diabetes

How is Dupuytren’s Disease Diagnosed?

Diagnosis is usually straightforward in later stages and involves a medical history review and physical examination. Early-stage diagnosis can be more challenging, and most people seek medical advice only after the disease has progressed.

What Are the Treatment Options?

In many cases, treatment is not necessary, as Dupuytren’s disease may remain mild and have minimal impact on hand function. If the condition worsens over time or begins to interfere with hand movement, treatment options are available.
Important Note: Exercises, splints, or medications have not been proven to stop or slow the development of Dupuytren’s contracture.

Will I Need Surgery

Surgical treatment is only recommended when hand function is significantly affected or likely to deteriorate soon. The goal of treatment is to restore or maintain hand function by addressing the contracture, though surgery is not a cure. Recurrence is common, with approximately 60% of cases recurring within 10 years.

Available Procedures

Fasciectomy

Procedure: The most common surgical option, this involves removing the abnormal thickened tissue in the palm and fingers through a zigzag incision. If the skin is adhered to the tissue, a small skin graft (dermofasciectomy) may be performed.
Outcome: This surgery can relieve the contracture and restore finger mobility.
Anaesthesia: Typically performed under regional anaesthesia (numbing the affected arm), but general anaesthesia may be used in some cases.

Needle Fasciotomy

Procedure: A minimally invasive option, where a needle is used to cut the thickened tissue under the skin.
Outcome: While recovery is quicker, there is a higher likelihood of recurrence compared to a fasciectomy.
Suitability: This option is best for mild cases, older patients, or those unsuitable for major surgery.

Potential Risks and Complications

As with any surgery, complications are possible. These include:

Incomplete correction: Full straightening of the fingers may not always be achievable, especially in longstanding cases.
Delayed wound healing or infection: Some patients may need antibiotics or additional procedures.
Nerve injury: Temporary or permanent numbness in the finger can occur.
Skin damage: Sometimes the skin is affected during surgery, requiring more time to heal, or a skin graft.
Recurrence: The condition may return and could involve other fingers.
Complex Regional Pain Syndrome (CRPS): Rarely, severe pain, swelling, and stiffness can develop and persist.

Despite these risks, most patients experience successful outcomes with minimal complications.

Before Surgery

Please remove all rings from your fingers before attending the hospital.

Post-Surgery Care

Dressing and Stitches: Your hand will be bandaged post-surgery. Keep the dressing dry and follow your hand therapists’ instructions. Dissolvable stitches are used.
Elevation: Keep your hand elevated as much as possible over the first 48 hours post-surgery to reduce swelling.
Follow-Up Appointments: Most patients will require hand therapy 3–7 days after surgery. Therapy may involve exercises and wearing a splint during the day (for approximately two weeks) and at night (for several months).

Returning to Activities

Driving: You can drive once you no longer need a splint during the day and feel confident in controlling your car. This is typically 2–3 weeks after surgery. For needle fasciotomy, this may be sooner.
Work: Return to work depends on the nature of your job. Light duties may resume after a few days, but heavy manual work may require up to 4 weeks of recovery.
Sports: Your ability to return to sports will depend on the type of activity. Discuss this with your consultant or therapist.

Additional Resources:

Contact Andrew Smith Contact Chris James