What is Dupuytren’s Disease?
Dupuytren’s Disease is an abnormal thickening of the deep tissue (fascia) in the palm and fingers. It often starts as lumpy nodules in the palm, but then can progress into the fingers causing them to bend down. This is called a Dupuytren’s Contracture.
Dupuytren’s Disease typically progresses with time, but the rate of progression is variable.
What causes Dupuytren’s Disease?
The underlying cause is not completely understood. There is thought to be a genetic component but other factors may contribute. It is more common in men than women and often starts in middle age but can be found in people in their 20s.
How is it diagnosed and what are the symptoms?
Dupuytren’s Disease is diagnosed by careful examination of the hands. Symptoms are variable and not everyone with Dupuytren’s Disease needs treatment straight away. Please discuss your symptoms and functional difficulties with your doctor.
What is the treatment?
The main stay of treatment currently is surgery, but there are a variety of options. The most common is fasciectomy, however there are other options that may be suitable or needed in a few cases.
- Needle Fasciotomy. A fine needle is used to divide the contracted cord.
- Fasciotomy. The contracted cord of Dupuytren’s Disease is simply cut.
- Fasciectomy. Through a longer incision the entire cord is removed. This is the most common operation.
- Dermofasciectomy. The diseased cord is removed together with the overlying skin and the skin is replaced with skin taken from the forearm. This is called a skin graft. This procedure is usually undertaken for recurrent disease or for extensive disease in a younger person.
- Amputation. This is not normally needed but maybe the easiest option in recurrent disease or when there is a very large contracture.
The amount of correction that will be achieved after your surgery will depend on various factors. Please ensure you have discussed this with your surgeon so that you have realistic expectations of your surgery.
After your operation you will initially be required to attend the hospital for regular hand therapy appointments. This is a specialist service which is only available at Yeovil Hospital and not at local community hospitals or GP practices.
These appointments are for wound care, exercise progression, advice and in some cases splinting. The number of appointments will depend on your operation and your progress afterwards.
Please ensure you are able to attend for all appointments as failure to do so will have a negative impact on the outcome of the surgery.
Before your operation
Please remove all jewellery from the hand before the day of your surgery. Tight rings may need the help of a jeweller to remove. Ensure that your hands and nails are clean and that any acrylic nails or nail varnish are removed.
All surgery has risks and these may vary with your individual circumstances. The following is a general guide:
Infection – This is rare after hand surgery (less than one per cent of cases), but can be serious. Lower your risk of infection by keeping your dressings clean and dry.
Nerve injury – It is rare to cut a nerve (less than one per cent of cases), but the nerves are often caught in the scar tissue and untangling them may cause some numbness on the finger. This may improve though can take some time.
Bleeding – Some blood on the dressing is common, but significant bleeding is rare.
Stiffness and swelling – This is common to a degree and can be reduced by elevation of the hand and moving the fingers.
Recurrence – Dupuytren’s Disease will typically recur over time, though how long this takes is variable. This means the contracture may return in the same finger or other fingers may be affected.
Inability to fully straighten the finger – It is usually possible to make a significant improvement in the bend of the finger, however scarring or severe Dupuytren’s Disease may mean that some bend may remain.
Complex Regional Pain Syndrome (CRPS) – This is an abnormal reaction to surgery which can lead to longstanding pain and stiffness and swelling. Severe CRPS is rare but can make you feel worse than before surgery and can be difficult to treat.
Skin graft – A skin graft is sometimes required to cover the wound. This is usually taken from the forearm where there will be a scar.
If the skin graft fails to survive the wound will take longer to heal.
Surgery is usually performed under general or regional anaesthetic. General anaesthetic means being asleep and is usually safe for most patients and preferred for longer operations.
Regional anaesthetic involves an injection of local anaesthetic around the nerves in the shoulder to make the whole arm numb.
This may be safer for some patients and an option for others. If you would prefer a regional anaesthetic please let us know when booking your operation as we will need to make arrangements for this. We need to prepare as if for general anaesthesia as the regional is occasionally not effective and this is determined before surgery begins.
Surgery usually involves a zig-zag incision from the palm into the affected finger(s). The nerves are identified and the Dupuytren’s tissue is excised to straighten the finger(s).
In some cases, if the finger has been bent for sometime, a joint release may be needed to help get the finger straighter. If this is needed a more intensive rehabilitation may be required to regain function.
Occasionally a skin graft from the upper arm is needed, if there is not enough skin to cover the finger, when opened out. A temporary plaster is applied in cases to help keep the fingers straight.
After the surgery, you will be offered pain relief medication to take for the first few days, it is advisable to take these regularly at first.
If you have had a regional anaesthetic (nerve block) your hand may be painful when the numbness wears off. Severe continuous pain should be reported to your doctor.
Your hand will either be placed in a large bulky dressing or in a Plaster of Paris back slab. All dressings should be kept clean and dry. It is advisable to cover your dressing with a large rubber sized glove or a plastic bag when showering or bathing.
You will provided with a sling to wear after the operation to keep your hand elevated. This needs to be removed regularly so you can stretch your arm above your head and bend and straighten your elbow.
It is important to keep your hand elevated to aid the reduction of swelling and prevent stiffness of your fingers. You can move your fingers within the limits of the dressings. Once the swelling subsides (which can take several weeks) you can start to leave the hand down.
An appointment will usually be arranged for two to five days after your surgery with a hand therapist in the therapy department. However, if your surgery includes a skin graft, this first appointment will be at approximately one week after surgery.
Please contact the therapy department if you are unable to attend this appointment to rearrange.
At this one hour appointment your dressings will be reduced and replaced with a lighter bandage. You will also be given exercises to prevent your fingers becoming stiff.
When can I use my hand?
You can use your hand for light functional tasks once in the lighter bandage ensuring you keep the dressings clean and dry. In between uses, continue to wear your sling and keep your fingers moving.
You will be shown exercises to perform, it is important to perform these exercises to increase the movement and strength in your hand and reduce scaring.
When will my stitches be removed?
Your stitches will be removed between 10 to 14 days after your surgery and is usually done by your hand therapist. Once the wound is fully healed you will be able to wash your hand and start massaging the scar with an aqueous non-perfumed moisturising cream.
Will I need to wear a splint?
In some circumstances you will be provided with a thermoplastic splint to wear at night. This is assessed on an individual basis and will be discussed with you if appropriate.
When can I return to driving and go back to work?
Following the removal of your stitches you can return to driving as long as you are comfortable and have enough strength and control to drive safely. How quickly you return to work depends on your job, the severity of the Dupuytren’s Contracture and extent of the operation. Generally you can return to light activity/secretarial work from about two weeks, moderate work from four weeks and heavy manual work from six weeks.
These are the earliest time scales for returning to work, however it can take longer.
Your surgeon or therapist can give you further advice.
The Hand Therapy Service is available Monday to Friday 8.30am-5pm
If you have any questions or require further information or advice during the above hours please contact:
Therapy department: 01935 384 358
Therapy fax: 01935 384 266
If you have any serious concerns outside these hours please contact your GP, Minor Injuries Unit or the hospital Emergency Department.
NHS Choices Dupuytren’s Contracture
The British Dupuytren’s Society
The British Society for Surgery of the Hand