Dupuytren’s Disease – What is it?

Dupuytren’s Disease is an abnormal thickening of the palm that limits movement of the fingers. In serious cases, a cord forms beneath the skin that stretches from the palm to the base of the fingers. The cord causes the fingers to bend into the palm so they cannot be fully extended. The disease can affect other areas of the body such as the knuckles of the fingers or the soles of the feet. The cause of Dupuytren’s is unknown, and there is no permanent cure, but the disease is harmless and painless.

Who gets it?

Dupuytren’s disease mostly affects white people with ancestors from northern Europe. It occurs more often in men than in women, and usually starts after age forty. In many cases, the disease runs in families (hereditary). Some people may develop a more severe form of Dupiuytren’s disease. There may be people who 1.) develop the disease at a young age, 2.) have the disease in areas other than the hand, 3.) have a history of liver disease caused by alcohol abuse, 4.) take medications to stop seizures from occurring. Injuries to the hand have not been directly linked to causing the disease.

What are the patient’s signs and symptoms?

Dupuytren’s disease usually shows up as a small bump or pit in the palm. This tends to occur near the crease of the hand that is closest to the base of the ring and little fingers (left image). With time, a cord may develop between the palm and the fingers. The disease is usually noticed when the palm cannot be placed flat on an even surface such as a table top (right image). In severe cases, drawing of the fingers into palm interferes with everyday activities like washing hands, wearing gloves, and putting hands in pockets.

How does the disease develop?

The disease most often begins in the palm of the hand at the base of the ring or little fingers. The lump or pit may show up months or even years before the cord develops from the palm to the fingers. Having the disease in both hands is common. Drawing of the fingers into the hands can occur at the joints at the base of the fingers or the joints in the fingers. The skin may be involved with the disease, but the tendons in the hand are not affected.

Is there a role for occupational hand therapy?

With less severe cases, occupational therapy can assist with maintaining optimal hand function through fabrication of splints or providing the use of assistive devices. It may also be helpful to begin an exercise/stretching program that maintains optimal range of motion in the tendons, thereby allowing the fingers to move as freely as possible. However, often the disease will progress despite best of efforts, and in these cases, surgery is necessary.

What is the role of surgery?

Surgery can relieve the bending of the fingers into the palm, but the condition can return within time. The goal of surgery for Dupuytren’s disease is to restore normal hand movement. Your doctor or therapist should advise you on whether surgery is recommended in your case.

What are some considerations of surgery?

The presence of the lump in the hand does not mean that surgery is required. Bending of the fingers into the palm at the base of the fingers is usually correctable by surgery. Surgery may not completely relieve bending of the fingers at the joints in the fingers. It is important to remember that surgery is not a permanent cure for the disease. After surgery, thickening of the palm and development of the cord may return in the same place or at a new place within the hand. Please consult with your physician or therapist for the best treatment strategy.