Can you lay your hand flat on a table? If not you may have Dupuytren’s contracture. Here Anne Sjoukje Schurer, Chair of the British Dupuytren's Society sheds some light on this difficult-to-pronounce disease.
Dupuytren's disease is a common but little known condition that affects the hands of up to 2 million people in the UK. In men it usually starts around the age of 50-60 years; women tend to get it a decade later. Dupuytren’s is caused by a build-up of collagen in the hand. For many people it will not progress further than a swelling (nodule) in the palm but others will experience bending of the fingers, most commonly the little and ring fingers, when the condition is then called Dupuytren's contracture.
Dupuytren's disease was named after Baron Guillaume Dupuytren, who was the first person to perform an operation on a hand with Dupuytren’s in 1831. Baron Dupuytren, considered to be the greatest French surgeon in history, is also famous for treating Napoleon's haemorrhoids.
Dupuytren's is inherited but can easily skip one or two generations. There is some suggestion that the disease was spread by the Vikings, hence the name 'Viking disease'. Iceland has a very high prevalence of Dupuytren's disease, and it is well known by Scottish bagpipers as 'McCrimmons curse'. However recent genetic testing has disputed the Viking idea. Dupuytren’s has also been found in an Egyptian mummy, suggesting the gene(s) have been around a lot longer.
It is seen mainly in Caucasians, and some famous sufferers include Margaret Thatcher, Bill Nighy, David McCallum, Jonathan Agnew, Ronald Reagan, and pianist Misha Dichter. It affects people from all walks of life, but it has been recognised as an industrial disease for people who have worked a long time with vibrating machinery.
How do you know if you have it?
Dupuytren's disease usually starts with a nodule in the palm, though some people get nodules in the fingers, and in some 'pitting' of the skin in the palm can be the first sign. This stage can be painful. The nodule will slowly develop a cord, in most cases toward the ring and little finger, but the rest of the digits can be affected as well. The cord can then start to contract, pulling the finger into a flexed position. At this stage the patient will start noticing that many every day, work and leisure tasks are becoming difficult. If the hand cannot be placed flat on the table anymore (Tabletop Test) most hand surgeons will recommend treatment.
The top ten things people with Dupuytren's contracture find the most difficult to do
Recently our charity carried out a survey on our Facebook page to find out what are the most difficult things to do when living with Dupuytren's contracture. Here’s what we found out:
1) opening jars or bottles or food containers
2) use car gear stick, driving
3) pushing or pulling trolley, pram, wheelbarrow, luggage
5) shaking hands
6) using thin kitchen tools, grater or zester
7) holding toothbrush, flossing or hairbrush, or hair dryer
8) exercise with weights, elastic cords, yoga
9) raking leaves, gardening, shovelling snow
10) using door handles or a handrail
Treating Dupuytren's contracture
The treatment for Dupuytren's depends on stage of the disease. In an early stage, when the nodules are forming and growing and there is no or not much contracture, radiotherapy is an option. If the disease develops and a contracture appears a specialist hand surgeon can cut through the offending cord with a needle or blade under local anaesthetic (needle fasciotomy). This procedure is most relevant in the early development of a contracture, is carried out in an outpatient setting but is associated with a high recurrence rate. Alternatively, the surgeon can inject the cord with collagenase, and after 24-72 hours, the cord is snapped by manipulating the fingers straight.
When there is a more severe contracture, surgery is an option. Fasciectomy is the most common procedure carried out in the UK. This is where the skin is surgically opened and the diseased tissue is removed. This allows the finger to straighten again. In some cases, a dermofasciectomy is performed where the overlying skin is also removed and replaced with a skin graft. This is the procedure with the lowest recurrence rate. It is important not to leave contractures too long as this can compromise the result you can achieve.
For a surgical opinion, search for a specialist consultant hand surgeon who carries out these procedures regularly. Most procedures will require a period of rehabilitation which is ideally led by a specialist hand therapist.
Who are the BDS?
The British Dupuytren's Society (BDS) is a UK charity which supports people with Dupuytren’s and related conditions, such as plantar fibromatosis, Peyronie's disease and frozen shoulders. We have a large following on Facebook and Twitter, and get regular emails from patients looking for advice or treatment options in their area. We work closely with several international Dupuytren's charities and follow the latest developments in research.
To find out more call us on 0808 101 0337 or make an online enquiry.