Dupuytren’s disease is a benign process characterized by the progressive thickening and contracture of the fascial bands of the palm and digits. This thickened fascia, typically described as nodules and cords, may lead to the contracture of the digits predominantly at the MP and PIP joints. The cellular and molecular mechanisms of contracture are now better understood however the cause is yet to be completely determined. Dupuytren himself first attributed the cause to a person’s occupation since he saw the disease in heavy laborers and coachmen. There is now no clear evidence that occupation or lifestyle, including smoking and alcoholism, play a role in the development of Dupuytren’s disease. Most epidemiologic studies point towards genetics with the disease having increased prevalence in Northern European populations and those with Northern European ancestry. Environmental factors may play a role as suggested by recent studies that show increased rates of the disease in Indian patients living in England while the rate of the disease in India is very low.
Surgery currently is the only treatment for Dupuytren’s disease and is indicated for progressive contracture of the fingers, although collagenase injections are currently in FDA trials. The goal of surgery is to straighten the fingers, however, this often requires prolonged postoperative nighttime splinting and hand therapy. Surgical treatment typically involves complete excision of the diseased tissue or “cords”. Severe contracture may require that the palmar incision remain open and allowed to heal secondarily over three to four weeks. In other instances, skin grafting may be necessary. Severe contracture often cannot be completely corrected and recurrence may be as high as fifty percent in some instances. Patients generally do not require daytime splinting and may return to work once the incisions have healed well, about 2 weeks post-op. Return to heavy labor may be postponed 4-6 weeks until grip strength returns. Recurrence is higher in those patients with onset before forty years of age and with Dupuytren’s diathesis (concurrent presence of foot nodules and Peyronie’s disease.) Non-painful nodules without contracture may be monitored while hand surgery consultation may be required at the first sign of a fixed flexion contracture.
Dr. Scott P. Olvey is a board eligible orthopaedic surgeon with the Center for Orthopaedic Surgery and Sports Medicine. He is fellowship trained in disorders of the upper extremity including: hand, wrist, elbow and total shoulder replacement.
The Center for Orthopaedic Surgery & Sports Medicine
8141 S. Emerson Ave., Suite. A
Indianapolis, IN. 46237