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Thumb base arthritis

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Dupuytren's Disease

What is Dupuytren’s Disease?

Dupuytren’s disease is a condition that affects the connective tissue beneath the skin of the palm and fingers. It leads to the formation of thickened, fibrous tissue, which can create nodules (lumps) as well as cords of tissue. These cords gradually pull the fingers towards the palm, causing contracture, which makes it difficult to fully straighten the affected fingers. The condition most commonly affects the ring and little fingers, but it can involve other fingers as well.

Causes and Risk Factors

Dupuytren’s disease is multifactorial, and while it is known to have a genetic component, the exact cause is not fully understood. Several factors are thought to contribute to the development of the disease, including:

  • Family history (Genetic predisposition)

  • Age (Most common in people over 50)

  • Male gender

  • Northern European descent

  • Diabetes

  • Alcohol consumption

  • Smoking

  • Epilepsy medication (Phenytoin)

Symptoms

Signs of Dupuytren's may include:

  • Nodules or small, hard lumps in the palm

  • Cords of thickened tissue forming under the skin, which can pull the fingers into a bent position

  • A dimpled or puckered appearance of the skin on the palm

  • Gradual curling of the fingers, particularly the ring and little fingers

  • Difficulty straightening the fingers fully, especially when reaching or gripping objects

  • In some cases, the condition may affect both hands or other parts of the body, such as the feet (Ledderhose disease) or the penis (Peyronie’s disease)

Diagnosis & Investigation

Dupuytren’s disease is typically diagnosed based on clinical history and physical examination, where the surgeon will assess:

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  • The presence of nodules and cords in the palm

  • The degree of finger contracture and range of motion

  • Family history and risk factors

Imaging tests (like X-rays) are rarely necessary unless there is concern about other conditions. In rare cases, an ultrasound may be used to assess the extent of tissue involvement.

Non-Surgical Treatment

While Dupuytren’s disease cannot be cured without surgery, several non-surgical treatments can help manage symptoms:

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  • Needle fasciotomy: A minimally invasive procedure where a needle is used to break the fibrous cords. This can often be performed in the clinic setting to improve finger movement.

  • Hand therapy: Aimed at improving flexibility and strength, especially after surgery.

  • Splinting: While splinting is rarely effective as a standalone treatment, it may be beneficial in the post-operative phase to support the healing process and improve the range of motion after surgery.

Surgical Treatment

If non-surgical methods are ineffective or the condition severely restricts hand function, surgery may be required. The most common surgeries for Dupuytren’s disease include:

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  • Fasciotomy: Cutting the fibrous cords to release the contracture, usually performed as an outpatient procedure under local anaesthetic.

  • Fasciectomy: A more involved surgery where the affected tissue, including nodules and cords, is excised.

  • Dermofasciectomy: Often reserved for severe disease or recurrent contracture, this procedure involves removing the fibrous tissue along with a portion of the overlying skin. A skin graft is usually required, which is typically taken from the antecubital fossa (the inner elbow area).

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Both fasciotomy and fasciectomy aim to improve the ability to straighten the fingers and reduce the severity of the contracture.

Recovery

  • Most patients regain improved finger movement once the wound has healed after surgery.

  • Hand therapy is usually recommended to improve flexibility and strength after surgery.

  • Normal activities can often be resumed in 4–6 weeks, depending on the extent of the surgery.

Risks

Although rare, surgery for Dupuytren’s disease may have complications:

  • Infection

  • Nerve or vessel injury

  • Scarring or stiffness

  • Recurrence of the contracture (the disease may return)

When to See One of Our Hand Specialists

You should consult a hand specialist if:

  • You notice any nodules or cords in the palm of your hand

  • You are unable to fully straighten one or more fingers

  • The condition interferes with daily activities like gripping, holding objects, or shaking hands

  • You experience pain or significant loss of function in your hand

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