Dupuytren's disease

What is Dupuytren's disease?

Dupuytren's disease is a progressive connective tissue disorder, which causes the fingers and thumb to contract towards the palm. It is not usually painful and gets worse over time. In the UK, 12,000 patients have surgery annually1.

Dupuytren's disease is more common in men than women and occurs most commonly in the little and ring fingers, the palm and the thumb. It can present in a variety of ways. It often begins with thickening or pits in the palm and over time it may cause the affected fingers to bend towards the palm (contracture). This tightening restricts the hand's ability to fully open and interferes with everyday function.

What can I do about my Dupuytren's disease?

At present there is no cure for Dupuytren's disease but there are various interventions to release the contractures, either surgical or an injection of collagenase followed by hand therapy.

It is important you discuss with your specialist whether you are a better candidate for collagenase or surgery as there are risks and benefits of both.

Collagenase:

In spring 2011, a new injection was licensed in the UK. This is the first non-surgical intervention for Dupuytren's disease and involves an injection into the affected tissue in the hand. This injection is collagenase and it “dissolves” the problem bands of Dupuytren's disease and this can help release the contracture.

This treatment is very new in the UK but over 5,000 of these injections have been given worldwide. It can only be given by specially trained hand surgeons – many of whom work in BMI Hospitals. To find out more about this treatment click here.

Surgical solutions:

There are multiple different surgical procedures available including Fasciectomy. This procedure removes the diseased tissue to allow the digits to straighten again. Achieving a full correction depends on a few factors including the timing of the surgery in terms of your disease. There are a variety of different ways a fasciectomy can be carried out. Your surgeon will give you more information about the types of treatment that could work for you and whether they think a full correction is achievable. Click here to read more about Dupuytren's disease surgery.

Should I have intervention?

Usually people consider treatment when the fingers begin to contract or bend forwards and interfere with daily activity. Successful treatment can correct this contracture and allow you to use your hand fully as the fingers straighten again. Your surgeon will advise you whether the time is right to have something done – sometimes it is best to see a consultant initially and return for regular reviews to time this correctly.

What happens after surgery and injection treatment?

You are likely to be able to go home the same day but occasionally an overnight stay is required. Post-operative hand therapy will ensure that you make a good recovery and minimise the scar tissue. This is very important as healing scar tissue can also tighten and if left unattended, can make the fingers contract again therefore mimicking Dupuytren's tissue. Once you have had surgery or injection treatment you still have Dupuytren's disease and therefore there is always a chance of the contracture recurring.

Specific exercises will be taught to you to help you regain your range of motion and return to normal activities as soon as possible. These exercises will be progressed as you heal and as you improve.

As a guideline, you should be able to return to most functional activities such as driving by four weeks. Exercises, managing the scar and splinting may continue up to six months under the guidance of your hand therapist.

1 J. J. Dias and J. Braybrooke “Dupuytren's Contracture - An audit of the outcomes of surgery” JHS (Br) 2006; 05.514-521