What is Dupuytren’s disease?
The cause of Dupuytren’s disease is largely unknown. We know that that there is an increased production of myofibroblasts, which produce a type of collagen that is not normally found in the hand, which causes thickening of the fascia, the fibrous contractile tissue layer under the skin of the palms, fingers and hands.
It’s a hereditary condition, more common in men, and the little finger is the most commonly affected digit. Other risk factors include hand trauma, smoking, diabetes, epilepsy, & increasing age. If left untreated, Dupuytren’s disease can cause the fingers to bend in towards the palm. With time the fingers involved become stiff and stuck in a bent position. It is usually a painless condition, although occasionally small lumps of the disease found in the palm can be tender.
Surgical treatment of Dupuytren’s disease
The most effective treatment option is a fasciectomy, a surgical procedure to remove the diseased fascia, and where a joint is stuck in a flexed position, to perform a joint release. The procedure is very successful, although the patient must bear in mind there is a recurrence rate with this condition which is approximately 20%.
A limited fasciectomy is another surgical option available, which removes a small amount of the affected tissue, but corrects the flexed finger deformity. There is a higher recurrence rate with this type of procedure, hence it is usually offered to the elderly patient who simply wants the deformity corrected to improve hand function.
Non-surgical Treatment of Dupuytren’s disease
Conservative treatments are available in certain less severe cases of the condition. A needle aponeurotomy involves a small needle being inserted into the thickened tissue to divide the contractile cord. This can be performed under local anaesthetic in the office.
Some patients find relief from the enzymatic drug Collagenase being injected into the diseased tissue. Collagenase works to break down collagen and soften and weaken the contracture. However, it is not currently on the Pharmaceutical Benefits Scheme, and will add to your out-of-pocket costs.
Recovery Following Dupuytren’s Surgery
For the non-surgical treatment options, return to work can be almost immediate. For surgical treatment options, depending on the demands of your job, you may be able to return to work in one to two weeks after the operation if you can manage your duties without using the hand. A lengthier recovery period will be required if your work requires putting pressure on your hand or heavy lifting. Our surgeons will help you to determine your plans for recovery. A course of hand therapy with a physiotherapist or occupational therapist may be prescribed, including practising exercises at home to help your fingers to increase in flexibility and prevent future problems. You may need to wear a hand splint for several weeks after surgery.
An Experienced Dupuytren’s Surgeon
As a plastic surgeon, Dr Turner has extensive experience and expertise in the treatment of Dupuytren’s disease. Contact Dr Turner and her team to organise a consultation to talk about the most suitable treatment to alleviate your symptoms and allow you to regain the function of your hand.