In Dupuytren’s disease, tissue under the skin in the palm of the hand, called the palmar fascia, gets thicker and tighter. This can cause fingers to bend in toward the palm causing functional limitations. It most often affects the ring and small fingers and may be in both hands.
While the exact cause is unknown, it is more common in those of northern European heritage, so there appears to be a genetic link. It’s often confused with trigger finger, but Dupuytren’s contracture features characteristic nodules, cords and pits caused by thickened tissue.
The disease has three general phases:
- In the early phase, there is a small lump in the palm of the hand, usually near where the ring finger and small finger meet.
- In the active phase, there is a dimpling on the skin of the palm. Long, ropey cords or bands form in the fascia.
- In the advanced phase, a fibrous cord forms in the fascia and pulls the fingers toward the palm, which is called a Dupuytren’s contracture. Over time, one is unable to fully straighten fingers or flatten a hand on a table. It may be hard or nearly impossible to do things like put on gloves, wash hands, or pick things up.
In most cases, Dupuytren’s does not cause pain and some do not notice it until a contracture develops. The disease usually gets worse slowly. In many people, it never causes major problems. Trauma can accelerate the Dupuytren’s process.
A thorough physical exam and medical history usually gives the physicians at ValleyOrtho enough information to diagnose Dupuytren’s disease and formulate an individualized treatment plan to ensure a safe and complete recovery.
The goal of treatment is to keep the hand working as well as it can. Treatment options include:
•A medicine called collagenase may be injected into the tight cord to dissolve some of the tissue to help reduce the contracture and improve finger range of motion.
•Surgical release of the diseased tissue in the palm.
•Rehabilitation with a hand therapist following collagenase injection or surgery will include splinting, therapeutic exercise, wound/scar management, and ergonomic education.