Jones The Hand
Dupuytren's Disease
What is Dupuytren's Disease?
Dupuytren's disease (or contracture) is a genetic condition affecting a sheet of tough tissue just beneath the skin of the palm. Patients develop thickening and scarring in this sheet, which results in lumps in the palm. These can line up to form cords in line with the finger. Over time, the cords can contract and pull the finger into a bent position.
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Some other factors can encourage the progression of the disease, such as high alcohol intake, diabetes, some anti-epileptic drugs and injury/surgery to the palm.
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It is not usually painful, though it can be in the early stages. Bent fingers typically cause difficulty with washing the face, putting on gloves or getting hands into pockets.
Treatment
I cannot offer any treatment which slows or stops the deformity from progressing. Some private providers offer radiotherapy in early disease to prevent progression, but I do not recommend this.
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In mild disease, especially if it is not causing the patient any bother, it is best left alone. Operating on the hand is a form of "injury" and this can make it worse. The condition usually progresses, causing a slowly worsening deformity over years. Sometimes it can cause a more rapid progression over a few months. It is unpredictable. Eventually, it stops progressing and the deformity doesn't get any worse, but by this time the fingers could be very bent and it may be too late to get them straight again.
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Usually when the deformity has become severe enough to cause the patient difficulty with their hand function it is reasonable to consider treatment to straighten the finger out. This can be done by a small procedure involving picking through the diseased tissue, or by surgery. The options available will be influenced by the individual patient's pattern of disease.
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The needle procedure and smaller operations to straighten the finger can be done under local anaesthetic alone. If the operation is a bit bigger, it is done as a daycase under regional anaesthetic (when the arm is put to sleep by injection but the patient remains awake). Occasionally a general anaesthetic is needed, and so any patient who is planned for a regional anaesthetic needs to be starved for 6 hours before surgery just in case.
Risks and Recovery
The hand is often placed in a plaster straight after surgery. This is removed when the patient has their first physiotherapy appointment after a few days and is replaced with a removable splint for use at night.
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Wounds heal by 2-3 weeks, at which point any non-dissovling stitches are removed. The patient returns to a good level of function by around 6-8 weeks, but can be longer depending on the amount of surgery done.
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The main risks from surgery are that it may not be possible to completely correct the deformity and that the condition can come back in the same fingers or in other fingers. If it ever gets bad enough, sometimes more surgery is needed. Sometimes healing time can be prolonged and, in severe cases, further surgery may be needed to encourage skin healing.
Other risks from surgery include infection, bleeding, damage to nerves/vessels/tendons in the area, cold intolerance, scarring, stiffness and a rare condition (1 in 1000 patients) where the hand can overreact to the operation resulting in pain, stiffness and swelling for many months.
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Most patients avoid complications and overall the results are good.
