Dupuytren’s Disease

This leaflet provides general information about Dupuytren’s disease (also called Dupuytren’s contracture) including the treatment options available. It is not a substitute for your doctor’s advice.

What is Dupuytren’s disease?

Dupuytren’s disease is a condition affecting the hands and fingers, pronounced “doo-pwee- tranhz”. It is named after the French surgeon, Baron Guillaume Dupuytren, who first described the condition in 1834.

Dupuytren’s disease occurs when a small lump of tissue develops in the connective tissue of the palm, usually where your ring and small fingers meet. Over time the lump can develop into a fibrous, rope like cord connecting your palm to one or more of your fingers. As this happens the finger is pulled down making it difficult to fully straighten (known as a Dupuytren’s contracture). It most commonly affects the little and ring fingers but can affect any fingers and/or thumb and can develop in both hands.

Dupuytren’s disease does not usually cause pain. When pain does occur, it is often early in the disease.

It is not a limb threatening condition but can interfere with certain functions of the hand such as putting the hand into a pocket and/or putting gloves on. The symptoms are often mild and do not need treatment. However, if it does get worse over time and function deteriorates, treatment can be offered.

How common is Dupuytren’s disease?

Dupuytren’s disease is a fairly common condition. It tends to affect more men than women and often happens in later life. It can affect up to two in every 10 men (20%) who are over 60 years of age and two in every 10 women who are over 80 years of age.

Dupuytren’s disease is most commonly found in white Europeans, and predominantly runs in families. Some other factors, such as heavy drinking, smoking, and diabetes, have been linked to the condition. The condition has a very strong genetic predisposition. In most people with Dupuytren’s disease there is no known cause or associated illness or injury. It is not due to your type of job, vibrating tools, manual work, or other working environments.

How is Dupuytren’s disease diagnosed?

Dupuytren’s disease may be difficult to diagnose in its early stages. Most people do not see a health professional until the disease has progressed. A medical history and physical examination usually provide enough information for your health professional to determine whether you have Dupuytren’s disease.

How is it treated?

Many people with Dupuytren’s disease do not need any treatment. In many cases the condition remains mild and causes little interference with the use of the hand. There may be just thickened tissue, or thickened tissue with a mild contracture. In these situations no treatment is usually advised.

There is no evidence to show exercise, splinting, or medications have any benefit on reducing the development of a contracture.

Will I need surgery?

Surgical treatment is needed only if the normal function of the hand is affected - or is likely to become affected soon. The goal of intervention for Dupuytren’s contracture is to maintain or restore hand function by relieving the contracture in the fingers. However, surgery is still not a cure for the disease, recurrence of Dupuytren’s disease is common but may take many years to recur.

What procedures are available?

There are several procedures varying in complexity and complications, and the choice of appropriate procedure is dependent on the presentation of the disease in each of your hands.

Fasciectomy
A partial fasciectomy is the most common surgical procedure carried out for Dupuytren’s contracture in East Kent. It involves removal of the abnormally thick and fibrous tissue in the palm and along the fingers through a ‘zig zag’ cut. If your palm skin has become stuck (adhered) to the abnormal tissue, the skin may be removed along with the tissue and a small skin graft applied (a dermofasciectomy). Surgery usually provides relief from contracture and restores mobility in the fingers.

The operation is performed in the day surgery unit. The operation is usually performed while you are awake using a regional anaesthetic, numbing only the arm affected. However, in some cases it may be performed under a general anaesthetic where you are asleep. Local anaesthetic is often injected around the cut at the end of the operation; this area and possibly some of the fingers will remain numb for many hours after surgery.

Needle fasciotomy
Needle fasciotomy involves the surgeon pushing a fine needle through the skin over the contracted cord. The sharp bevel of the needle is used to cut the thickened tissue under the skin. This procedure is done under local anaesthetic (the area is numbed but you are awake). There may be a higher rate of reoccurrence for Dupuytren’s contracture following a needle fasciotomy but it is easier to perform and quicker to recover from. Patients have to be selected carefully to get the best outcome. Needle fasciotomy can be suitable for older patients who are unsuitable for surgery; or if the contracture is only affecting the knuckle joint. You will be advised if it is an option for you.

What are the risks and possible complications from surgery?

Complications, as with any surgery, can occur but with Dupuytren’s contracture they tend to be relatively mild. For needle fasiotomy, the rate of complication is low, at around 1% (one in every 100 patients). For fasciectomy, studies have found complication rates to be higher, around 5%.

Complications can include:
• incomplete correction – it may not be possible to fully straighten the finger, particularly if the finger has been bent for a number of years;

delayed wound healing or infection – a small number of patients will develop an infection and may need antibiotics or a wash out procedure (more common in patients with diabetes);
nerve injury – the contracted tissue is wrapped around the small nerves in the finger, and a small proportion of patients may be left with some permanent or temporary loss of feeling along the finger;
collection of blood or blood clots in the hand tissues (haematoma) – this may need a second surgical procedure to remove the blood clot;
damage to the skin - which results from trying to surgically separate the skin from the diseased tissue. It may take a little longer for the wound to heal or the patient may need a skin graft during the procedure;
recurrence – Dupuytren’s is a disease that can come back and also affect other fingers. Approximately 60% of patients will have a recurrence of their disease within 10 years.
complex regional pain syndrome – this is a rare condition but can cause severe pain, swelling, and stiffness in the hand which can take several months to improve or may even continue.

Despite the list of complications and risks, please remember that the vast majority of patients have an uncomplicated routine procedure with very satisfactory recovery and outcome.

How do I care for my hand after surgery?

After surgery, your hand will be bandaged with a well-padded dressing which you must keep dry. It is important to keep your hand elevated as much as possible to reduce the swelling.

Unless otherwise stated you will have dissolvable stitches This will be clarified with you when you have your surgery. You should keep your surgical dressings in place until your first therapy appointment.

Will I need a follow-up appointment?

The majority of patients will need to be followed up by the hand therapy service around three to seven days after your surgery. The therapists will remove your dressings and check your wound. You will be given exercises and a removable splint to protect your hand (see image). This is likely to be worn during the day time for approximately two weeks and at night time for several months after surgery. However, if you have had a dermofasciectomy your therapy will not begin until seven to 14 days after your surgery.

Some simple needle fasciotomy procedures may not need formal hand therapy and you will be given self-care information.

Therapy may be needed for at least six weeks, depending on how quickly your wound heals and how quickly you regain normal movement in your hand. It is important to remember that your therapist is only there to guide you; it is up to you to do most of the work.

How soon after surgery can I drive?

Driving can start as soon as you feel confident enough to control your car safely and you are no longer wearing the splint during the day. This is usually after about two to three weeks. Needle fasciotomy patients can return to driving much sooner.

When can I return to work?

Return to work depends on the type of work you do. Someone who does heavy manual work may not be able to return for six weeks after having a skin graft. An office worker may be able to return to light duties a few days after having surgery. The same applies to sport and the type of sport you play.

Further information

If you have any questions regarding your diagnosis or the surgery, do not hesitate to contact your consultant or therapist.

Please remove all rings from your fingers before coming to hospital on the day of your surgery.

For further information can be found on the following web pages or web sites:

www.england.nhs.uk/wp-content/uploads/2022/07/Making-a-decision-about-Dupuytrens-contracture.pdf