Dupuytren’s Disease: Causes and Treatments for the Palm

Currently, the cause of Dupuytren’s disease is not fully understood. However, genetics do play a key role and most patients have family members with this condition. Besides genetics and family history, there are multiple factors that can contribute to the development or worsening of this disease.

Risk factors for Dupuytren’s Disease:

• Men are more likely to develop this condition than women.
• Older patients are more likely to develop this condition than younger ones.
• Excessive alcohol intake may be associated with Dupuytren’s Disease.
• It is more common in people of northern European and Scandinavian descent, such as Swedish, Norwegian, Finnish, Irish, Scottish, and English.
• Medical conditions such as Ledderhose disease and Peyronie’s disease are associated with Dupuytren’s Disease.

Dupuytren’s disease progresses very slowly and can take even months to years to worsen or affect hand and finger function. Any finger can be affected, but most commonly Dupuytren’s disease affects the ring finger. This condition is not typically painful. If a patient has pain with this condition, there is usually a different underlying cause for the pain.

Symptoms of Dupuytren’s Disease include:

• Painless nodules or lumps in the palm of the hand and fingers.
• Rope-like cords in the palm of the hand and fingers that can tighten over time and bend the fingers down into the palm.
• Finger contractures and stiffness.
• Inability to straighten the fingers.
• Decreased grip strength.
• Inability to grasp large objects.

During the exam, the physician will carefully examine the hand and fingers for any nodules and cords. The rope-like cords in the palm and fingers may look like tendons, however, tendons are not involved in this disease process.

Patients are also instructed to lay their hands down flat on the table to determine if there are any contractures in the fingers. The physician will then measure the severity of the contractures. X-rays may be helpful to evaluate for arthritic changes in the finger joints. MRI and CT scans are not necessary to diagnose this disease.

At this point in time, there is no cure for Dupuytren’s Disease. However, some people only have mild forms of the disease and never develop contractures. These patients do not need any treatment for the lumps and nodules in their hands. Additionally, removing the nodules does not prevent them from coming back.

For patients who have contractures that prevent them from doing daily activities, there are several non-surgical and surgical options. The goal of any treatment is to improve range of motion and function of the hand and fingers. First, needle aponeurotomy is a technique in which the sharp end of a needle is used to cut the Dupuytren cords through the skin. However, this is a blind technique and has risks of damaging surrounding nerves and vessels. It is only reserved for specific type of cords in the hand.

Another more recent technique uses Xiaflex, which is a collagenase enzyme, that is directly injected into the Dupuytren cords. The medication is FDA approved. It acts as a knife to break up the cords in the palm and hand. The Xiaflex injection has similar functional results to surgery but avoids extensive incisions and therefore has a quicker recovery time compared to surgery. It is a great option for patients who cannot have surgery as well.

Surgery is the last option. The procedure involves open surgical resection of the involved fascia in the palm and fingers. It is typically performed in a surgical center under local or regional anesthesia. A splint is applied after either non-surgical or surgical treatment to help keep the fingers straight and prevent them from curling back down. The most common complication following treatment is a recurrence of the Dupuytren’s contractures. All three treatments described, needle aponeurotomy, Xiaflex injections, and surgical resection have a similar rate of recurrence.