Dupuytren’s Disease

IMG_2688Named after the French Napoleonic Surgeon Baron Dupuytren, this is a common condition affecting the hand characterised by nodules or cords starting in the palm. In a third of patients the nodules will progress into cords which can cause digital contracture. The little and ring fingers are most affected. The aggressive form of Dupuytrens, is characterised by radial (thumb and index) sided disease, bilateral disease, ectopic disease (eg in the feet), early age onset and strong family history.

 

The cause is unknown but we know that there is a genetic predisposition and people of Northern European (‘Viking’) heritage are particularly affected. It was previously thought to be associated with the ’good life’ (heavy smoking and alcohol consumption) but there is not enough evidence to back this up. There is an association with diabetes. Trauma /injury can accelerate the onset

 

Treatment

If function is unaffected then no treatment is necessarily required.
The interventional options are:

Xiapex (collagenase) injections – depending on disease severity

Needle fasciotomy

Selective fasciectomy

Total fasciectomy

Dermofasciectomy (usually in the revision setting)

The available evidence does not support the use of radiotherapy for Dupuytren’s.
Surgery is usually followed with splintage and hand therapy.