Dupuytren’s Disease

Dupuytren’s contracture (also known as morbus Dupuytren, Dupuytren’s disease, or palmar fibromatosis, and sometimes misidentified as Dupuytren’s constricture) is a fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended (straightened). It is named after Baron Guillaume Dupuytren, the surgeon who described an operation to correct the affliction.

Dupuytren’s contracture is caused by underlying contractures of the palmar aponeurosis (or palmar fascia). The ring finger and little finger are the fingers most commonly affected. The middle finger may be affected in advanced cases, but the index finger and the thumb are nearly always spared. Dupuytren’s contracture progresses slowly and is usually painless. In patients with this condition, the tissues under the skin on the palm of the hand thicken and shorten so that the tendons connected to the fingers cannot move freely. The palmar aponeurosis becomes hyperplastic and undergoes contracture.

Incidence increases after the age of 40; at this age men are affected more often than women. After the age of 80 the distribution is about even.

Treatment

Often no treatment for Dupuytren’s is necessary, but even with it there is no permanent way to stop or cure the condition. Amputation of fingers may be required for severe or recurrent disease, or as a complication of surgical treatment.

Surgery

Surgical management consists of opening the skin over the affected cords and excising (removing) the fibrous tissue. The fingers may then be brought out to length with the help of postoperative therapy. The procedure is not curative in that remaining non-affected fascia may still develop Dupuytren’s disease later on, and therefore the patient may need repeat surgery. In addition, the thickened fascia often is near to or wrapped around the digital nerves and arteries, so there is risk of nerve and/or arterial injury. A 20-year review of surgical complications associated with open surgery (fasciectomy) for Dupuytren’s showed that major complications occurred in 15.7%, including digital nerve injury 3.4%, digital artery injury 2%, infection 2.4%, hematoma 2.1%, and complex regional pain syndrome 5.5% in addition to minor complications including painful flare reactions in 9.9%, and wound healing complications in 22.9%