Dupuytren’s Disease

Dupuytren’s disease (or contracture) is a common hand and finger condition, and is especially seen in Scotland and northern Europe. Early in the disease, firm nodules appear just beneath the skin of the palm and sometimes in the fingers. In a proportion of affected patients the nodules elongate to form cords that can cause one or more fingers to curl in towards the palm (limiting straightening of the finger). Only about 1 in 3 people with Dupuytren’s nodules will develop a future finger deformity, with any contracture usually progressing slowly (over many months or years). The ring and little fingers are most commonly affected. 

The condition is named after the late French surgeon Guillaume Dupuytren who described the disease in the early 19th century. There is no cure for Dupuytren’s disease and the condition can recur following surgical treatment.

There are other causes of finger stiffness and skin lumps and bumps and a thorough assessment will help to identify the cause.

Has your finger curled in towards the palm over months or years?

  • The cause of Dupuytren’s disease is not well understood; however, it commonly runs in families (but not always) and is sometimes referred to as the ‘Viking disease’ due to its higher incidence in people with northern European ancestry. Other risk factors may include diabetes, smoking and high alcohol intake, but many affected people often have none of these.

    Only about 1 in 3 people with Dupuytren’s nodules will develop a future finger deformity. If contracture occurs, the rate of progression is highly variable but may be more rapid among men, those aged under 50 years, those with a strong family history, and involvement at other sites (such as the feet or penis).

  • Some of the potential symptoms of Dupuytren’s disease are listed below.

    Typically present:

    • Firm nodules and/or cords in the palm and/or fingers.

    Sometimes present:

    • Finger contracture (bending) towards the palm that limits full finger straightening, which has occurred over many months or years. Any finger can be affected but the ring and little fingers are most common.

    Less commonly present:

    • Nodule pain or discomfort (uncommon and usually settles).

    • Nodules or contracture (narrowing) in the webspace between the thumb and index finger.

    • Thickened skin over the back of the finger knuckles (termed Garrod pads).

    Other conditions that are associated with Dupuytren’s disease include nodules on the soles of the feet (called Ledderhose disease) and penile curvature in men (called Peyronie’s disease).

  • It is important to correctly diagnose Dupuytren’s disease and exclude other causes of skin changes or finger stiffness and bending, such as arthritis and trigger finger. The diagnosis is usually made on the history (your symptoms) and clinical examination.

  • Although Dupuytren’s disease can provide functional difficulties when finger bending or contracture occurs, the condition is otherwise harmless and many people will never require treatment, especially if the fingers aren’t too badly affected. 

    • Non-surgical treatment options for Dupuytren’s disease are very limited, with splintage, stretching and massage not proven to slow or alter the progression of finger contractures. Many will learn to adapt and manage with their changed finger position.

    Dupuytren’s disease can also be treated by the injection of a substance called collagenase (an enzyme that breaks down the disease); however, this treatment is no longer available outside of North America.

    • Surgical treatment options for Dupuytren’s disease are varied and include needle fasciotomy (a minimally invasive procedure that cuts but does not remove the diseased tissue) and fasciectomy (open surgery to remove the diseased cords and nodules). Fasciectomy is also commonly called limited fasciectomy. More severe forms of Dupuytren’s disease (including recurrent disease following previous surgery) may be treated with dermofasciectomy, whereby the disease and overlying skin is removed and a skin graft is placed over the wound (which is taken from your forearm leaving a second scar). Although dermofasciectomy can help reduce the risk of recurrence, the risks of this surgery are increased when compared to fasciectomy alone.

    Surgery for Dupuytren’s disease aims to improve finger position, although a fully straight finger is not often achieved. Although Dupuytren’s disease can recur (it cannot be cured), the majority who undergo fasciectomy or dermofasciectomy will often only ever have one operation (rates of recurrence are highest for needle fasciotomy).

    Matthew offers all of the above treatments. Physiotherapy and splintage is usually required following surgery for Dupuytren’s disease.

    Needle fasciotomy is performed under local anaesthesia. Open surgery (fasciectomy and dermofasciectomy) is usually performed under general or regional anaesthesia. Click here for an overview of the different types of anaesthesia and the general risks of hand surgery. The additional and specific risks associated with the different operations will be discussed if surgery is an option, but can include incomplete finger straightening, stiffness, numbness, cold intolerance (finger pain in cold conditions), and very rarely amputation of the finger due to loss of blood supply. 

    According to a UK population-based research study, the 10-year risk of repeat surgery in the same hand for recurrent contracture is around 1 in 3 (34%) following needle fasciectomy, and 1 in 5 following both fasciectomy (20%) and dermofasciectomy (18%). Additionally, a serious local complication can occur in around 1 in 100 patients (1.2%) having surgery for Dupuytren’s disease.

  • You can read more detailed information regarding Dupuytren’s disease on the Lothian Hand Unit website here. 

    The British Society for Surgery of the Hand (BSSH) has an informative webpage on Dupuytren’s disease which can be downloaded as a patient information leaflet PDF.