Dupuytren's Disease?

Pronounced Du-pwe-tranz, Dupuytren's contracture was given its name by a

French surgeon in 1831, however, the condition had been recognized well before then. It is a hereditary condition which is thought to have originated with the vikings and is therefore very common in Northern Europe and people of Scottish or Irish ancestry. For this reason it is sometimes known as Vikings disease.


So what exactly is Dupuytren's Disease?

Just below the skin on our palms we have a layer of connective tissue called the palmar fascia. In people with Dupuytren's disease, the palmar fascia becomes thickened. Often the first sign is a small lump in the palm and there may be puckering of the skin near the lump.

Dupuytrens' Disease
Puckering of the skin in very early Dupuytren's disease
Dupuytren's Disease
Dupuytren's nodules in line with the ring finger

The condition tends to appear after the age of 50 and affects men more commonly than women. For some people the disease may not progress any further than the nodules near the crease in the palm. For other people, over time there may be further thickening and shortening of the fascia which causes tight bands to form. These bands are sometimes mistaken for tendons because the cord-like appearance is a little like a tendon, but the condition does not involve the tendons.

Dupuytren's contracture in the little finger

Dupuytren's contracture can affect any of the fingers or even the thumb, but it most commonly affects the ring or little finger. Usually over a period of years the shortening of the fascia may cause the finger to bend towards the palm. Unlike trigger finger, which can cause a finger to temporarily get stuck in a bent position, in Dupuytren's contracture, the shortening is permanent. This can lead to problems with sliding the hand into pockets, shaking hands or putting on gloves.





How is Dupuytren's treated?

There is currently no cure for Dupuytren's contracture. If the bent finger is getting in the way, a surgeon can cut the diseased tissue from the palm, to allow the finger/s to straighten. A splint is usually worn at night for at least 3 months following surgery to help ensure that the finger remains straight afterwards.


Can anything be done to prevent Dupuytren's from progressing?

Traditionally it has been thought that there is nothing that can be done to prevent the disease from progressing but there have been a couple of studies which have shown that wearing a splint at night can improve the straightening of the finger. As splinting does not change the disease process, the splint would need to be worn on an ongoing basis to maintain the improvement, but it may help to delay the need for surgery.


Reference

A clinical trial of tension and compression orthoses for Dupuytren's Contracture, Brauns,A.B., Van Nuffel,M., De Smet, L., Degreef, I. Journal of Hand Therapy 30(2017) 253-261.

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