Dupuytren’s disease

About Dupuytren’s disease

In the UK, more than two million people are thought to have Dupuytren’s disease. It’s more common in people over 50, and especially in men. It particularly affects people from a northern European background and runs in families.

Symptoms of Dupuytren's disease

Dupuytren's disease begins with firm lumps or nodules forming in your palm, often in line with your fourth (ring) finger. These are caused by thickening of the layer of tissue just under the skin. These nodules aren’t usually painful.

About one person in three who has Dupuytren’s disease will find the nodules progress and increase in size to form rope-like cords that pull the finger towards the palm and prevent it straightening fully. Although it can look as if it’s your tendon causing this, in fact it’s the thickened layer of tissue below your skin causing the problem. Without treatment, one or more of your fingers may become fixed in a bent position. This process is known as contracture. The process of your fingers becoming contracted is usually slow, and happens over many months and years rather than within weeks. 

Dupuytren's contractures

Causes of Dupuytren's disease

The cause of Dupuytren’s disease isn’t known but it appears to run in families. Other factors that seem to increase the chance of developing this condition are: 

  • being over 50
  • being male (eight out of 10 people with this condition are male)
  • being from a northern European descent
  • having diabetes
  • smoking
  • drinking excess alcohol

There is some evidence that the condition could be made worse by certain types of manual work, especially the use of vibrating tools. A one-off hand injury may, in rare cases, trigger the start of Dupuytren’s disease.

Diagnosis of Dupuytren's disease

If you think you have contractures caused by Dupuytren’s disease and it’s affecting your hand function, see your GP. He or she will ask about your symptoms and examine you. He or she may also ask you about your medical history. One test you may be asked to carry out is to lay your hand flat, palm down on a table. This won’t be possible if you already have Dupuytren’s contractures.

Treatment of Dupuytren's disease

There are a variety of treatments for Dupuytren’s disease that aim to straighten your fingers. The most common treatments involve some form of surgery. 

Medicines

You’re unlikely to be offered any medicines to treat Dupuytren’s disease because none have been proven to work yet.

Collagenase injection (Xiapex)

This is a new treatment that has recently been authorised in the UK. Collagenase is a protein that can break down the contracted cords. Collagenase is injected into the affected cord and the next day the treated joint is carefully manipulated to try to make the cord break. You’re likely to be given a splint to wear at night for up to four months. There is evidence that about two-thirds of people who had this treatment found that their fingers could almost fully straighten again. However, collagenase treatment isn’t suitable for all people who have Dupuytren’s contractures.

Surgery

There are a number of different types of surgery. You will need to discuss with your surgeon which option is most suitable for you.

Needle fasciotomy

This is the most minor, minimally invasive surgery. This option is more likely to be considered if you can’t have a general anaesthetic because this type of surgery is carried out under local anaesthesia. Local anaesthesia blocks pain from the area where the needle will be inserted into your skin and you will stay awake during the procedure. Your surgeon will insert a needle through the skin on top of the contracture and use it to divide the cord of Dupuytren’s tissue.

Needle fasciotomy can give a short-term improvement in the severity of a contracture. However, your contracture is likely to return, although this depends on the severity of your disease before the surgery was carried out.

You can have this procedure again in the future if your contracture returns.

Fasciectomy

In this operation, your surgeon will make a cut in your palm and affected fingers, and remove the thickened tissue beneath the skin that is causing the contracture. This can be carried out under regional or general anaesthesia. Regional anaesthesia completely blocks the pain from your hand or arm and you will be awake during the procedure. With general anaesthesia you will be asleep for the whole operation. The contracture comes back in up to six out of 10 people who have this procedure, so you may be offered dermofasciectomy, which has evidence of a lower recurrence rate.

Dermofasciectomy

This is a more complex surgical option that involves removing both the outer skin layer and the underlying thickened Dupuytren’s tissue. This is done under general anaesthesia. A skin graft, usually taken from your arm or groin, will be needed to replace the outer skin layer that has been taken away. You’re more likely to be offered this type of operation if the outer skin layer is involved in your contracture, if the contracture started when you were younger (under 50) or if the disease keeps coming back after previous operations.

Radiation therapy

You will usually only be offered radiation therapy during the early stages of Dupuytren's disease and probably only as part of a research study. The nodules and cords are treated with radiation with the aim of reducing their size and slowing their progression. There isn’t a lot of evidence about how well it works. Also, it may be better to wait to see if your nodules begin to form contracture cords because in many people this doesn’t happen. Further research into this procedure is being encouraged.

Living with Dupuytren's disease

You may find that having Dupuytren’s disease doesn't cause you many problems. However, if it becomes severe enough to affect your life so that daily tasks become difficult, see your GP.

Does what I eat affect my chances of developing Dupuytren's disease?

Answer

The greatest risks for developing contractures caused by Dupuytren’s disease are being over 50, male, and having other family members who also have the disease. There is little evidence that what you eat can influence whether you get Dupuytren’s disease.

Explanation

Although your diet isn’t likely to have a big impact on your likelihood for developing Dupuytren’s disease, it’s still important to take a healthy approach to what you eat. Having type 2 diabetes seems to be related to the development of contracture caused by Dupuytren’s disease, but this may be mainly because both these conditions can also run in families. You can help reduce your chances of getting diabetes by eating a healthy, balanced diet that is low in saturated fat, salt and sugar and high in fibre, fruit and vegetables. Regular exercise can also help reduce your risk of developing diabetes. You should aim to do some physical activity every day. The recommended healthy level of physical activity is 150 minutes (two and a half hours) of moderate exercise over a week in bouts of 10 minutes or more. You can do this by carrying out 30 minutes on at least five days each week. Alternatively, you can do 75 minutes of vigorous intensity activity.

Can you drive with contractures caused by Dupuytren's disease?

Answer

There are no specific guidelines from the Driver and Vehicle Licensing Agency (DVLA) about this disease but you should only drive if you feel able to maintain control of the vehicle.

Explanation

Dupuytren’s disease in the early stages is unlikely to prevent you from driving. However, if the disease progresses you may find that your contracted fingers make it difficult to hold the steering wheel and drive safely. You may find other tasks also become more difficult and so you may want to visit your GP to discuss treatment options.

What complications could occur with surgery?

Answer

There are a number of complications that may occur with the different surgical options. These vary in severity and the exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Explanation

Although you will probably recover more quickly after a needle fasciotomy than other types of surgery, there is still a chance of complications including cuts in the skin around where the needle is put in, pain, damage to nerves or tendons and infection.

Complications occur more frequently with fasciectomy and dermofasciectomy compared with needle fasciotomy, and are more likely if you have severe or recurrent disease.

Initial complications include:

  • finger nerve injury
  • haematoma – localised swelling filled with blood
  • infection
  • your fingers not being fully straight – you may need to have further surgery
  • ischaemia – lack of blood supply to your hand
  • pain
  • stiffness
  • skin loss
  • wound healing problems

It’s possible to have long-term complications, which could include:

  • complex regional pain syndrome – a chronic pain condition with the main symptom being continuous, intense pain that is out of proportion with the severity of the injury, and that gets worse rather than better over time
  • Dupuytren's 'flare' – stiffness, pain and oedema (a swelling of your hand and arm caused by a build-up of fluid) two to three weeks after surgery
  • vasomotor disorders – problems with the nerves and muscles that control the size of blood vessels in your hand

When I go to sleep my finger begins to curl inward; is this a symptom of Dupuytren's disease?

Answer

This doesn’t sound like a typical initial symptom of Dupuytren’s disease.

Explanation

Initial symptoms are nodules (a thickening of the underlying skin) and pits in the palm of your hand, usually starting below your fourth (ring) finger. If you can fully move your finger when you’re awake, the curling as you go to sleep is unlikely to indicate the start of Dupuytren’s disease.

A condition that may be causing the curling of your finger is trigger finger. This affects the tendons in your finger and results in the finger bending towards the palm of your hand. You may find you have to pull the affected finger with your other hand to release it. Another condition that could cause this symptom is carpal tunnel syndrome. This also involves the tendons in your wrist and hand that can lead to weakness in your hands. You may have other symptoms caused by carpal tunnel syndrome that include pain or burning sensations in your hands.

See your GP if you’re worried about your symptoms.