What is Dupuytren’s disease?
Dupuytren’s disease (often called Dupuytren’s contracture) is a thickening of the fibrous tissue underneath the skin of the palm and fingers. Dupuytren’s is not actually a disease, but rather a disorder; it is characterized by a benign (non-cancerous) proliferation of cells in the hand. This proliferation of tissue can lead to a contracture, which is the shortening and hardening of soft tissue causing deformity and rigidity in the hand. This contracture and proliferation starts in the palmar fascia, a fibrous band of connective tissue that runs along the palm. The tissue affected by Dupuytren’s is disproportionately made up of type III collagen, which is the collagen present in wound healing. It also has contractile properties, which is what leads to the contractures that characterize the disease. Dupuytren’s is inherited, occurring mostly in Caucasians of northern European descent; for this reason, it is sometimes called the “Viking Disease.”
Who gets Dupuytren’s?
Anyone can get Dupuytren’s disease, but there is a very strong genetic basis for the condition. The most common patient with Dupuytren’s is a white male in their sixth decade of life. However, it can occur as early as the third decade of life and is also found in women, albeit far less often. When presenting young, Dupuytren’s tends to be very aggressive.
Signs and Symptoms of Dupuytren’s:
Dupuytren’s usually starts with a painless bump in the palm of the hand. Often, those affected notice a small lump or a “pucker” of the skin in the palm. Over time, these lumps may grow or proliferate causing a contracture of the surrounding soft tissue. Dupuytren’s does not hurt unless you try to stretch out the contracture. As the contracture worsens, patients often complain of an inability to place their hand in certain positions, like flat on a table.
What are treatments for Dupuytren’s contracture?
For many patients with Dupuytren’s, intervention is not necessary. A painless bump or a ‘cord’ does not need intervention if it has not led to a contracture. The primary indications for intervention are a contracture equal to or greater than 40° of the metacarpophalangeal joint (knuckle) or any contracture of the proximal interphalangeal joint (the first joint of the finger). If intervention is necessary, the two primary treatment options are surgery or an enzyme injection called Xiaflex. Given its genetic basis, nothing will ‘cure’ a patient of Dupuytren’s. Your physician will decide which type of treatment is best for you based on the location and severity of the contracture being treated.
What is Xiaflex?
Xiaflex is an injection of clostridium toxin. It cleaves, or breaks down, type-III collagen and works very well to disrupt cords and straighten fingers in patients with a Dupuytren’s contracture. It is a surgical procedure. Great results can occur with Xiaflex, and most studies have shown it to be about equal to surgical treatment in safety and recurrence over the long term. More information can be found at https://www.xiaflex.com/
Surgery for Dupuytren’s contracture.
If a patient can’t use their hand appropriately or if the PIP joint is affected, your physician may determine that surgery is your best option. Surgery for a Dupuytren’s contracture is performed in the outpatient setting and requires your surgeon is break up or remove the palmar fascia that has hardened into a contracture. Often times, patients will require therapy after surgery. Surgical outcomes are greatly affected by the degree of contracture and the length of time the contracture has been present. For example, surgical correction of a 90° PIP contracture averages roughly 45° of residual contracture over the long term. Clearly, it is very important to seek medical treatment early on, before the contracture becomes severe and your chances of full recovery are impacted.