what is it?
This a condition
which mainly affects adult males,
involving the palm of the hand and the fingers. Connective tissue (palmar fascia)
right under the skin begins to thicken and shorten which
causes development of contracted cords and nodules in the
palm. It is the shortening and tightening of these cords that causes the
fingers to draw down toward the palm. This is a genetic
disease and is fairly common, most prevalent in men with
northern European hereditary backgrounds. Onset of disease
is usually in the fifth or sixth decade, with more
aggressive forms starting at an earlier age. A greater
incidence of Dupuytren's contracture is found in individuals
with epilepsy (where anticonvulsant medications suspected to
be the stimulus), diabetes, alcoholism, HIV, and smoking.
Trauma and exposure to chronic hand vibration may also exacerbate
The disease usually begins with a palm nodule (can resemble a callus) that develops at the base of the
ring or little finger. Gradually a prominent cord develops as the palmar fascia thickens. As
the process continues the overlying skin puckers, dimples, and roughens. The thick cords contract slowly over time, drawing the fingers into the
palm and may draw adjacent fingers together. The ring and little finger are most commonly affected and usually are
affected first. Progression is often erratic and arbitrary with no obvious cause.
Associated conditions include the formation of pads on the top of the knuckles
called "knuckle pads", fibrous plaques on the penis called
"Peyronie's Disease", and a disease syndrome on the bottom
of the feet, similar to what takes place in the palm,
called "Ledderhose's disease".
Needle Aponevrotomy or surgical intervention are the only methods
available for correction of this
disease. Aside from NA, non-surgical treatments have not been effective. Steroid injection into nodules may reduce pain, and
traction devices may minimally undo contracture for the pre operative patient to achieve better surgical results.
Indication for treatment with either NA or surgery = CONTRACTIONS OF THE FINGERS. Combined flexion
(drawing down) of the joints of
the finger (MCP, PIP and DIP joint) exceeding 10-20 degrees should be released.
There is no need to wait for The first joint of
the finger (PIP) is more difficult to release than the large knuckle joint in the hand (MCP).
There is no
cure for this disease. NA and surgery have the same rate of recurrence - about 50% of patients
experience recurrence of the disease within 2 or 3 years.
CURRENT METHODS OF TREATMENT
Needle Aponevrotomy (NA): This is an outpatient procedure. A small hypodermic
through a skin prick is used to divide and release the contracting bands.
Regional Fasciectomy: this is the most common surgical treatment of Dupuytren's contracture. This procedure completely excises
the diseased fascia of the palm and digits. Requires general anesthesia or nerve block. Long rehab and wound care
Fasciotomy: Hand incision or multiple incisions are made above the hardened Dupuytren's cord and sharp dissection is performed to
facilitate release. Diseased tissue is not removed.
Dermofasciectomy: Removal of diseased fascia as well as diseased skin overlying diseased
fascia. This diseased skin is replaced
with a skin graft taken from patients arm. Long rehab and wound care are needed, recurrence is somewhat less with this technique.
Non-invasive Pneumatic balloon extension procedure: a metal plate fitted to the palm. This plate secures a balloon and pneumatic
assemblage where the patient can slowly increase the pressure to facilitate extension/traction. This device is primarily used to straighten severely contracted digits so
that then will be more amenable to a surgical methods as described above.
All of the following are controversial yet they possibly
influence the course of Dupuytren's:
Citrus fruit, unsaturated fatty acids of native olive oil, and soybeans are all
said to contain specific scavengers, which may give explanation to the lack in prevalence of Dupuytren's in the
Mediterranean and Asian populations.
Vitamins A, C, D, E, and selenium may have a protective function.
Steroids, Allopurinol, and Colchicine may slow the fibro proliferation of the disease.
Interferon, Nifedipine and Verapmil are other drugs that
were tried with limited success.
Collagenase: This enzyme is injected into diseased fascia causing it more or less to dissolve. Still in clinical trials but shows great
Due to the rapid progress in biotechnology, someday we hope to be able to eradicate Dupuytren's disease through gene therapy.