Dupuytren's disease is caused by a shortening, thickening, or excess of connective tissue in the palm of the hand. The contracture can extend into the fingers. Firm nodules, cords, and pits in the palm can develop. Over time, the fingers can be pulled into a bent position downward into the palm. While the cords may appear to look like tendons, Dupuytren’s disease does not involve tendons.
The University of Michigan hand surgery team is not only experienced in traditional methods of treatment, but also offers a revolutionary new treatment approved by the FDA for those affected by Dupuytren's disease.
Risk Factors for Dupuytren's Disease
Although the causes of Dupuytren's disease are unknown, there are factors that coincide with its incidence:
- Most common in men of northern European descent, 40 years or older.
- Men are more likely to develop Dupuytren's disease than women by a ratio of 3:2.
- Dupuytren's disease tends to run in families, but is not always consistently inherited and can be found without a family history.
Symptoms of Dupuytren's Disease
The symptoms of Dupuytren's disease are noticeable. The two fingers most often affected are the ring and little fingers.
Signs and Symptoms:
- Often affects both hands
- Lumps and pits under the skin of the palm that may be tender or painful
- Thick cords on the palm in line with the fingers
- Cords causing bending or contracture of the fingers into the palm
- Inability to place the hand flat on a table
- Inability to grasp large objects
- Difficulty putting hands into pockets
Dupuytren’s disease is not typically painful. The nodules and cords can grow over time, but they are not cancerous. There is no cure for Dupuytren’s disease, but there are treatments that can return functionality to the affected hand(s).
Diagnosis of Dupuytren's Disease
A history and physical examination with your doctor will allow diagnosis.
Treatment of Dupuytren's Disease
For a long time, treatment for Dupuytren's Disease was limited to surgery. In recent years, however, new treatments have become available. Our specialized hand surgeons work with patients to identify the best course for their particular health and lifestyle.
Monitoring: In mild cases, we recommend monitoring the thickened tissue for progression. If the disease progresses enough to cause problems with daily hand use, there are various treatment options. We recommend discussing these options with your hand surgeon.
Surgery: A procedure that removes the diseased tissue is called fasciectomy. This procedure is usually a very effective method of treatment. However, the recovery time can be long, especially if the skin is in bad condition and skin grafts are needed. Skin grafting requires months of recovery, and physical therapy may be necessary. Recurrence of the disease after this surgery is about 20%.
XIAFLEX Injections: The University of Michigan is also using a new FDA-approved treatment for Dupuytren's disease: clostridial collagenase (XIAFLEX) injections that destroy the excess collagen causing the thickening and shortening of the tissue. In some cases, only one injection is needed to dramatically improve the function of the hand. More complex cases may require a series of two or three injections for full treatment.
Treatment with Xiaflex is a two-step process. At the first visit, the medication is injected into the selected Dupuytren’s cord. The next day, a stretching procedure is used to break up the weakened cord and extend the finger. Both of these steps are performed with local anesthesia for comfort.
Recovery time and need for physical therapy are dramatically reduced with injections compared to traditional surgical treatment. The early results of this treatment indicate that it is nearly as effective as surgery, but long-term recurrence rates have not yet been determined. Possible side effects include several days of soreness or bruising in the arm and hand, blisters or minor skin tears, and very rarely injury to other structures such as tendons. Patients can expect an bruising, blisters or minor skin tears to heal in a short period of time.
XIAFLEX injections may not be performed by all hand surgeons. Please ask if your surgeon provides this treatment when booking your appointment.
Needle Fasciotomy: In select cases, the contracted, diseased tissue can be weakened by simply puncturing it with a needle multiple times through the skin. This procedure can be performed under local anesthesia and give quick results, much like Xiaflex injectison. However, the rate of recurrence after this procedure appears to be higher than other treatments.
If you are considering treatment for Dupuytren’s disease, the University of Michigan hand surgeons will guide you, from consultation to recovery, to the best procedures for your individual needs. Our hand surgeons have dual appointments in Orthopaedic and Plastic Surgery with a specialization in Hand. Patients may be seen in the Orthopaedic Clinic or the Plastic Surgery Clinic for treatment of hand conditions, or referred to Physical Medicine and Rehabilitation for non-surgical treatment.
Visit the Make an Appointment at the Comprehensive Hand Center page for contact information for both surgical and non-surgical treatment teams.