What is Dupuytren’s Disease?
Dupuytren’s disease (also known as Dupuytren’s contracture) is a condition that affects the layer of tissue under the skin of your palm. Thick knots of tissue form under the skin, eventually creating a thick cord that can pull one or more fingers into a bent position. The affected fingers cannot be straightened completely, which can complicate everyday activities like putting on gloves or shaking hands.
How is Dupuytren’s Disease Diagnosed?
In most cases, doctors can diagnose Dupuytren’s contracture by the look and feel of your hands. Diagnostic tests are rarely necessary. Your physician will likely perform the following:
- Physical Examination: Your doctor will compare your hands and check for puckering on the skin of your palms. They will also feel for toughened knots or bands of tissue.
- Tabletop Test: You may be asked to place your hand flat on a table. Not being able to flatten your fingers against the tabletop indicates a contracture.
- Grip and Pinch Testing: Checking the range of motion and functional strength of your fingers.
Management and Treatment
Nonoperative Management
If the condition is progressing slowly, causes no pain, and has little impact on your ability to use your hands for everyday tasks, you may not need treatment. Instead, you can wait to see if it progresses.
- Observation: Regular check-ups to monitor the progression of the cords and nodules.
- Collagenase injection (Xiaflex): A minimally invasive technique where a medication (enzyme) is injected to break the cords that are pulling the finger into a bent position. This usually treatment usually requires two visits, one to inject the medication, and another a few days later to manipulate the hand.
Operative Management
If the contracture is severe or interfering with hand function, surgical intervention may be required to remove or break apart the cords pulling the fingers.
- Fasciectomy: This is a common surgical procedure where the diseased thickened tissue is removed to restore finger motion.
- Recovery: After surgery, physical therapy and wearing a splint during recovery are often necessary to maintain the improved range of motion and ensure the best functional outcome.