Dupuytren’s disease is a relatively common disorder involving the palm of the hand and fingers. There is a tissue in the palm called “palmar fascia” that helps to support the skin in the palm. The palmar fascia holds the skin tight to deeper structures, so that skin is not mobile when we use our hands for grasping. In Dupuytren’s disease, the palmar fascia will thicken. In earlier cases this involves small nodules that are present in the palm. These are typically adherent to the skin and may be painful. In more advanced cases, the fascia can contract so severely that one will see a cord-like structure in the palm. As this progresses, the finger can be drawn into a bent position.
Early in the progression of the disease, it is difficult to predict which people will simply have nodules, and which will progress to a contracture.
The main underlying cause for Dupuytren’s disease is genetic. It is more common in people of Northern European ancestry, although, it may be seen in all races. Dupuytren’s disease’s pattern of inheritance is called “variable penetrance.” This means that although every generation in a family may have the gene, not every generation will manifest the gene. This is why, for example, a patient may not have parents or children with Dupuytren’s disease, but may have a distant relative with the clinical manifestations.
There are several options for treating Dupuytren’s disease. If there are simply nodules in the palm, but full movement and no pain, then this is simply observed. If there is a significant contracture that is impairing function, then treatment is considered. The traditional treatment involves surgery. The surgery involves opening the palm and possibly the finger and removing the diseased tissue to facilitate straightening of the finger. This is usually outpatient, takes about an hour, and is done under regional anesthetic.
There is about a month of rehab and therapy afterwards. The results of surgery are typically good and outcomes are typically related to the severity of the contracture before surgery. The milder the contracture, the better the results. In very severe contractures, sometimes complete correction is not obtained.
Another option is “Xiaflex” Injection. This is an injectable material that dissolves the cord. It is an in office injection. The day after injection the finger is manipulated to facilitate straightening. The early results are encouraging and are similar to traditional surgical results. Regardless of the technique, there is a chance of recurrence of the contracture, and again the chances of recurrence are based on the severity of the contracture.
This can be a challenging disorder to treat. Dr. Gove offers both surgery and Xiaflex, depending on the specific medical indications and patient preferences.