Dupuytren's Disease 

Introduction

Dupuytren’s disease causes an abnormal thickening of the tissues located underneath the skin in the palm of the hand.  As the tissue thickens it can form lumps and strong cords.  The abnormal growth causes the fingers to bend in towards the palm of the hand.  Severe symptoms can cause contractures and loss of hand function.  Dupuytren’s disease generally progresses slowly, but progression is unpredictable.


 

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Anatomy
The palm of your hand contains ligaments and tendons.  Ligaments are strong bands of tissues that connect your bones together.  Tendons attach muscles to bone.  The tendons in the palm of your hand flex or bend your fingers inward.  Your ligaments and tendons are covered and kept in place by the palmar fascia, a thin sheet of connective tissue.  The palmar fascia is located just beneath your skin.

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Causes
The cause of Dupuytren’s disease is unknown.  It may be associated with abnormal biochemical processes in the palmar fascia.  It is more common in people of Northern European descent.  It occurs more frequently in men than in women.  Dupuytren’s disease is rare among young people and more common in people over 40 years old.  If it occurs in young people, the condition tends to be very severe and quickly progressing.
 
Smoking and drinking alcohol increase the risk of Dupuytren’s disease.  Certain medical conditions are associated with an increased risk of Dupuytren’s disease.  Such conditions include diabetes, thyroid problems, epilepsy, pulmonary tuberculosis, and liver disease.

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Symptoms
The onset of Dupuytren’s disease is very slow.  Both hands may be affected, but usually one hand is more affected than the other.  You may notice a small tender lump in the palm of your hand.  The tenderness will go away as Dupuytren’s disease typically is not painful.  Over time, tough cords may form beneath your skin.  The thickened tissue may cause your fingers to bend inward toward your palm.  Your ring finger and little finger are affected most often.  You may have difficulty straightening your fingers. 
 
The progression of Dupuytren’s disease is unpredictable.  For some, the condition may consist of a lump or thickening of the tissue.  Other people may experience severe symptoms, including contractures and loss of hand function.

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Diagnosis
Your doctor can diagnose Dupuytren’s disease by examining your hand.  You should tell your doctor about any symptoms and if they restrict the use of your hand.  Your doctor will look at and feel the skin on the palm of your hand for thickened tissue or nodules.  Your doctor will observe your finger positioning and test the movement of your finger joints.  You may be asked to perform the Table Top Test, in which you will attempt to place your open hand on a surface and flatten your palm and fingers out as far as you can.  This will be difficult in the presence of finger contractures. 

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Surgery
The goal of surgery is to increase the movement of your fingers and restore their correct positions to improve hand functioning.  This may be attained in several different ways.  Your surgeon may simply divide the thickened bands in a procedure called fasciotomy.  The sheet of diseased palmar fascia may also be removed, and is called a fasciectomy.  In some cases, a skin graft may be necessary.

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Treatment
There is no way to stop the progression of Dupuytren’s disease.  Your doctor will monitor the progress of your disease.  Injections may help relieve the pain in a lump that has formed early in the disease process.  Injectable enzymes to dissolve the diseased tissue are being studied, but are not yet commercially available.  Surgery is recommended if the fingers become flexed enough to interfere with the functional use of your hand.
 
Following surgery, you will participate in rehabilitation with a hand therapist.  You will receive therapy treatments to aid wound healing, reduce swelling and ease pain.  You will be instructed in strengthening and stretching exercises.  You will perform hand coordination exercises and work towards improving your hand grip and finger pinching skills.  Your hand therapist will provide you with a splint to position your hand and promote healing.

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Recovery
Surgery is not always a permanent solution for Dupuytren’s Disease.  The condition tends to gradually recur over time. 

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.