Dupuytren‘s disease is a benign condition that affects the palms of the hand and the fingers, in most cases the ring finger and little finger. It affects mostly people over age 50 and is more common in men than women and can affect both hands at the same time.
The cause is not known but it does run in some families. If it runs in your family then drinking alcohol, smoking and diabetes can increase your chances of getting it. Having a Dupuytren's finger often interferes with everyday tasks such as carrying bags, typing, wearing gloves, steering, putting your hands in your pockets and shaking hands. This is because the affected finger(s) may bend into the palm and get completely stuck.
At first it may feel like you have a small hard lump on your palm close to one of your fingers that is a little tender to touch but doesn't affect movement in any way. Over time the lump thickens and sticks to connective tissue (fascia) in the surrounding palm and may form a pluckered pit in the skin. The thickened tissue is painless but continues to develops tight chords extending into the finger(s) and they pull the finger down towards the palm.
This painless process is not life threatening and happens over years in most cases and not in weeks. (Read about
trigger finger for information about other types of palm lumps).
Unfortunately it won't make any difference what you do to try to straighten your finger by massaging it, applying creams or stretching it. The only way to correct the position of the finger and regain movement is to have medical treatment.
An examination will involve measuring the degrees of movement in the affected finger joints to determine how advanced the thickening of the palm fascia is and how many joints are bending as a result of the chords reaching the finger.
Occupations that have increased risk factors are those using vibration tools including a steering wheel or any type factory machine vibration. If you have had a wrist fracture it also increases the risk of developing Dupuytren's contracture although why this is so is not understood.
Complications:
- Complications that arise are mainly due to the loss of ability to do everyday tasks or finger injury from accidentally getting the finger caught in something.
- Very tight chords can make it difficult to wash behind the bent finger and will increase the risk of bacterial or fungal infection.
- If the finger has been pulled down for a long time the skin can shorten meaning that a skin graft may be part of the surgical procedure to release the chords
Not all people who have small nodes of thickened fascia in their palms will develop chords that pull the finger down. In some cases it doesn't progress any further than the palm so it is normal practice to wait and see before having surgery to remove the chords.
Treatment for Dupuytren's contracture is usually only required if the condition affects the function of your hand. Many cases are mild and don't need to be treated.
The treatment used largely depends on the severity of the condition. In milder cases that require treatment, non-surgical treatments can be tried. A popular method involves the surgeon injecting an enzyme called Collagenase into the palm. The patient is sent home over night while the Collagenase dissolves the chords. The next day the surgeon will straighten the finger and a Hand therapist will make a small hand based splint to rest the finger for the initial 48 hours and at night times after that.
For more severe cases, surgery is an effective and widely used treatment. The two most common surgical procedures are an open fasciotomy and a fasciectomy. Both involve cutting the chords away and stitching the skin afterwards. Hand therapy to rehabilitate the hand afterwards is essential.
The disease may unfortunately return in a very small percentage of people and that is why it is important to wear your night splint in the same way that you would wear a retainer following orthodontic braces to keep the position and prevent recurrence.
Hand Kinetics can make you your resting night splint following surgery to prevent recurrence and to keep the healthy position of your finger.
Weekly Hand therapy for up to 6 weeks will be necessary after surgery to monitor progress , adjust your splint and to show you how to care for your surgical scar. It is very important to learn how to build strength in muscles and joints which may have been stuck and not able to move for a very long time.
Gradually more difficult daily activities can be resumed as healing continues and Hand therapy can help you to recognise your post surgery limitations until you are back to normal.
It will be important to have follow-up treatment at 3 and 6 months to check that the condition is stable.
Please note:
If you have had arm or hand surgery please telephone to discuss this before attending. It is always helpful to bring any reports you may have if you recently attended hospital for your hand or arm condition.
Hand Kinetics Telephone: 0044 28 417 72301
www.handkinetics.com
contactus@handkinetics.com
