Dupuytren's disease is a common condition resulting in painless contractures of the fingers.
It often runs in families and has been linked to Anglo-Saxon inheritance. For this reason it has been sometimes called "The Viking's disease", with the gene spread during the Viking invasion of northern Europe.
There are other factors in its development such as excessive alcohol, trauma and the medication used for diabetes and epilepsy. Men are more affected than women, and it mainly develops between ages 40-80 years.
Most commonly it causes thickening within the fascia of the hand, which is a normal structure that provides attachment of the skin to deeper structures allowing us to use our hands for gripping.
With Dupuytens's disease these fascial cords develop lumps and cords deep to the skin.
As they grow they also contract, pulling the finger down into the palm.
Over time the finger becomes more bent and the hand function is disturbed, resulting in difficulty putting on gloves, shaking hands, and holding objects.
It can however affect other parts of the body containing fascia, such as the soles of the feet and the penis.
Early disease can be managed by gentle massage and stretching. Treatment is required when you are unable to place the hand flat on the table.
Treatment options are either non-surgical or operative treatment.
Various types of non-surgical treatment have been used, many of which have low success and high recurrence rates. These include radiation therapy and the injection of cortisone.
Collagenase, which was harvested from bacteria, had the best results. It involves an injection of a small dose into the cord under local anaesthetic, followed by manipulation of the finger two days later.
The recovery was much quicker than surgery, the patient satisfaction was high, but unfortunately three years ago it became unavailable in Australia, and at this stage there is no indication if it will reappear.
Needle aponeurotomy involves breaking the cords with an hypodermic needle under local anaesthetic, but unfortunately it has a high recurrence rate of 70 per cent at five years.
Since collagenase is currently unavailable in Australia, the mainstay of treatment is now surgery.
It requires admission to hospital, and either local or general anaesthetic.
After dissecting out the vessels and nerves to protect them, the band of Dupuytren's tissue is removed and the finger is straightened.
Recovery is quite slow, with extensive physiotherapy, inability to use the hand for two weeks, driving at three weeks, and wearing a splint at night for four months.
Most patients recover well and the chance of recurrence is low, but it does require exercises and therapy to get the best results, with the hand being a little swollen and stiff for up to a year after surgery.
- Associate Professor Chris Roberts is an orthopaedic surgeon.
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