COMMON DISORDERS
Dupuytren's disease
Dupuytren's disease (also referred to as Dupuytren's contracture) is a common condition that usually arises in middle age. Firm nodules appear in the ligaments just beneath the skin of the palm and in some cases they extend to form cords that can prevent the finger straightening completely.
The cause.
It is unknown, it is more common in Northern Europe than elsewhere and it often runs in families. Dupuytren's disease may be associated with diabetes, smoking and high alcohol consumption, but many affected people have none of these. It does not appear to be associated with manual work. It occasionally appears after injury to the hand or wrist, or after surgery to these areas.
Clinical.
Dupuytren's disease begins with nodules in the palm, often in line with the ring finger. The nodules initially can be uncomfortable on pressure, but the discomfort almost always improves over time. In about one affected person out of every three, the nodules extend to form cords that pull the finger towards the palm and prevent it straightening fully. Without treatment, one or more fingers may become fixed in a bent position. The web between thumb and index finger is sometimes narrowed. Contracture of fingers is usually slow, occurring over months and years
Treatment.
There is no cure and surgery can usually make bent fingers straighter, but cannot eradicate the disease. Over the longer term, Dupuytren's disease may reappear in operated digits or in previously uninvolved areas of the hand. But most patients, who require surgery, need only one operation.
Surgery.
It is not always needed, depending on a number of factors, including degree of contracture, speed of progression, your expectations/ needs and your general health, just to mention the most important factors. I will be more specific after I have examined you. Normally, you would need to see me when it has become impossible to put the hand flat on a table. If you have reached this stage, you will need to seek advice at the earliest opportunity. I can advise on the type of operation best suited to you and on its timing. The procedure maybe carried out under local, regional (injection of local anaesthetic at the shoulder) or general anaesthetic.
Surgical options.
-
Fasciotomy. The contracted cord is simply cut in the palm, in the finger or in both, using a small knife or a needle.
-
Limited fasciectomy. Short segments of the cord are removed through one or more small incisions.
-
Regional fasciectomy. Through a single longer incision, the entire cord is removed.
-
Dermofasciectomy. The cord is removed together with the overlying skin and the skin is replaced with a graft taken usually from the upper arm. This procedure is usually undertaken for recurrent disease, or for extensive disease in a younger individual and helps prevent recurrence.
After surgery.
For the first week, your hand will be in a bulky bandage, resting in a sling. You will have to take regular oral analgesia and limit your activities to a minimum.
At the end of the first week, the dressing will be replaced with a simple one which will be kept for another week.
At 2 weeks following surgery, stitches will be removed and you will start hand therapy.
It normally takes approximately 3 months to go back to full activity.
Driving.
It is not allowed during the first week postop, since the bulky bandage would be a problem and your insurance will be temporarily invalid. We will discuss this in detail during our preoperative briefing and consenting in the clinic.
I may need to prescribe a splint, to be worn at night for 6 months.
Hand therapy is a very important element in the overall management and we will have to make an early referral to your local NHS service. Private/ insured patients have additional options.
Depending on whether you are a NHS patient or private/ insured, hand therapy will be organised either by your GP or myself.
Final recovery.
The degree of improvement achieved is variable but usually satisfactory. The final outcome is dependent on many factors, including the extent and behaviour of the disease itself and the type of surgery required. I will tell you more during our meeting in my clinic.
