Dr Steve Carter

ORTHOPAEDIC SURGEON

Dupuytren's Disease

Dupuytren's disease or contracture is caused by a thickening of the palma fascia. The fascia is normally a very thin flat layer in the palm of the hand. In Dupuytren's disease this fascia starts to contract and can gradually over time start to pull the fingers into the palm of the hand. This is not a painful process, but can significantly interfere with activities of daily living as you are no longer able to straighten your fingers. Imagine washing your face with a finger that is poking in your eye!

Dupuytren's disease is largely hereditary, particularly common in males and usually starts after the age of 50. The original gene defect came out of Scandinavia in the 12th Century so some people refer to it as the "Vikings Disease".

The patient first notices a lump, or nodule or "cord" in the palm of the hand, particularly common in the ring or little finger.

The disease is variable and may just remain as a lump in the palm for many years without a contracture developing. It can be precipitated by trauma or surgery to the hand.

When do we need to intervene? The standard criteria are 35° contracture at the MCP joint or 20° contracture at the PIP joint. Practically speaking if you place your hand on a table palm up and you are unable to place all the nails onto the table (ie full extension of the fingers) you need to see a surgeon.

Treatment

No contracture = No treatment. With a contracture surgery is indicated. There are a variety of methods available, from a limited fasciotomy to a more extensive fasciectomy. This obviously depends on the stage of the disease. In practical terms the cord is cut to allow the finger to achieve full extension. There is now available an injectable collegenase called Xiapase which is able to dissolve the cord. Preliminary results appear to be good for early contracture. It is not available in South Africa and the expense at present is prohibitive.

Dupuytren was a French physician and you can see a statue of him in the Hospital behind Notre Dame Cathedral if ever you are in Paris!

Dupuytren's is a day case surgery either under general or local regional anaesthetic. The length of surgery can vary, but typically is about 40min. Nylon sutures are placed in the skin, and a bulky dressing applied. The dressing is changed at day 3 to a light elastoplast.

A splint is made by the occupational therapists which is worn at night for 3 months. This is to make sure the hand stays straight. Physiotherapy is commenced immediately. The idea is we want you to use your hand as much as possible. So continue with all your normal activities of daily living.