Dupuytrens Contracture

Dupuytrens is a disease that originates from the Scandinavian peninsula, the so-called Viking disease. It is a progressive hand deformity that affects a layer of tissue that lies under the skin of your palm causing cords and nodules which lead to flexion contractures of the joints of the fingers, and an inability to open one’s hand completely. It is twice as common in men, and also starts at a younger age.  The incidence also increases with increasing age. Mostly it is a painless, but the nodules may occasionally be sensitive, especially if in weight bearing areas of the palm.

In rare cases there is an aggressive form of the disease which occurs in younger patients and may affect the under-surface of their feet, the back of their hands or even their genitals.


Earlier onset disease is usually more aggressive and has a higher recurrence rate. Dupuytrens is diagnosed at the consultation and does not require any ancillary tests. There are thick cords in the palm and fingers. These cords will occasionally wrap around and displace the nerves supplying the fingers, so there may be some subtle numbness or tingling in the hand or fingers affected.


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  • Management
Management

Non-operative

Non-operative measures such as stretching exercises or night extension splinting will not slow the progression of the disease. There is some evidence that radiotherapy may slow the progression of the disease, but this is mostly reserved for younger patients who present with early disease.

Operative

Surgery is indicated if the flexion contractures of the digits are impacting the patient’s daily activities. Surgical options to treat the disease are patient specific, as certain techniques are more appropriate for certain types of Dupuytren contracture.

Collagenase (Xiaflex®) is an enzyme that degrades connective tissue and is used in some centres overseas to treat Dupuytrens. It can be injected into the affected area and then 48 hours later the surgeon breaks the cord by stretching the finger under local anaesthetic. It is not available in South Africa.

Percutaneous needle fasciotomy is a technique where the cord is cut using the angle of a hypodermic needle but is only suitable in well-defined cords in the palm.

Open fasciectomy is the procedure that is most often performed for Dupuytrens and may be partial, complete or with excision of the overlying skin (a dermofasciectomy), although this is usually only very advanced cases.

Note, it is impossible to cure Dupuytrens by completely resecting all of the cords, so recurrence thereof is inevitable. However, the more of the disease you resect the longer the intervening period before recurrence.

After surgery the hand will be in a resting extension splint for 7 days, after which the sutures are removed and rehabilitation with an occupational therapist is begun. Rehabilitation is key in this to maintain tendon gliding and actively retain the gains made at surgery. The surrounding tissues need to be stretched and swelling and scar management is the hand therapist’s expertise, so they can be of significant assistance in this rehabilitation process.

Conditions Managed



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